Comparison Of The Clinical Effect Of Three Arthroscopic Rotator Cuff Repair Techniques:A Network Meta-analysis And Systematic Review

Purpose:A Bayesian network meta-analysis combining direct and indirect evidence was performed to assess the comparative effectiveness of arthroscopic techniques for the treatment of rotator cuff tear.Method:PUBMED,EMBASE and CENTRAL were searched and clinical trials that evaluated arthroscopic techniques for the treatment of rotator cuff tear were identified in July 2017.The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale and risk of bias using the Cochrane Collaboration tool.The primary outcome measure was the retear rate.The secondary outcome measures included Constant score and range of motion(external rotation and forward flexion).Result:Twenty-one trials comprising 1815 shoulders were included in the study.SR(single-row)repair resulted in a higher retear rate compared with DR(double-row)and SB(suture bridge)repair.Moreover,SB repair resulted in a lower incidence of retear than SR and DR repairs.The rank of treatments in terms of Constant score as well as external rotation was SB repair,SR repair and DR repair,whereas treatments were ranked with regard to forward flexion as SB repair,DR repair and SR repair.Conclusion:SB repairs have the highest probability of improving the functional outcome and reducing the incidence of retear among the three arthroscopic techniques for treating patients with rotator cuff tear.