Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

payt.helady61 shared this article with you from Inoreader Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis Via BMJ Open recent issues Objective To appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs). Design Systematic review and meta-analysis. Data sources MEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020. Eligibility criteria All studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions. Data extraction and synthesis Screening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane). Results We included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias. Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI –0.74 to –0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%). Conclusions While several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations. Prospero registration number CRD42017057908. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.