Background Multiple surgical strategies have been developed for treating massive rotator cuff tears (mRCTs). However, there is still no consensus on the best surgical option for mRCTs. Through a network meta-analysis, we aimed to comprehensively and systematically analyse the evidence in randomized controlled trials to help clinicians make evidence-based clinical decisions for patients with mRCTs. Methods Our study was a network meta-analysis of the surgical management of mRCTs (PROSPERO Registration ID: CRD42023397971). We searched PubMed, EMBASE, Cochrane and Web of Science for randomized controlled trials that examined the efficacy of surgical management for mRCTs up to 3 November 2022. A three-step method was employed for the study process. Study selection, data extraction and risk of bias evaluation were conducted by two independent reviewers. R software (version 4.2.1) and Stata (version 15.1) were used for the data analysis. Results From 10,633 publications, we included 15 randomized controlled trials (996 participants) for the quantitative analysis. In terms of both long-term and short-term surgical effects, there were no statistically significant differences among surgical interventions such as patch-augmented rotator cuff repair (RCR), RCR with platelet-rich plasma, arthroscopic decompression, bridging reconstruction, arthroscopic RCR with platelet-leukocyte membrane, open RCR, mini-open RCR, arthroscopic debridement, superior capsular reconstruction, arthroscopic suture-spanning augmented repair, subacromial balloon spacer and latissimus dorsi tendon transfer. Based on algorithms, the probability ranking suggests that patch augmentation is the most highly ranked surgical intervention for achieving better short-term surgical outcomes. Furthermore, arthroscopic-associated mini-open RCR was ranked as the highest surgical intervention for achieving better long-term surgical effects. Conclusions Based on the available data from the included studies, similar surgical efficacies were observed among the reported intervention measures for mRCTs. The patch augmentation technique was found to potentially achieve better short-term surgical outcomes, which is consistent with previous reports. However, the best surgical interventions for achieving long-term surgical effects remain unknown. More high-quality research is needed to evaluate the efficacy and safety of these interventions and to guide clinical practice.

中文翻译：

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大量肩袖撕裂的手术治疗：随机对照试验的网络荟萃分析。


背景 已经开发出多种手术策略来治疗大量肩袖撕裂 (mRCT)。然而，对于 mRCT 的最佳手术选择尚未达成共识。通过网络荟萃分析，我们旨在全面、系统地分析随机对照试验中的证据，以帮助临床医生为 mRCT 患者做出基于证据的临床决策。方法 我们的研究是 mRCT 手术管理的网络荟萃分析（PROSPERO 注册 ID：CRD42023397971）。我们检索了 PubMed、EMBASE、Cochrane 和 Web of Science 中的随机对照试验，这些试验检验了截至 2022 年 11 月 3 日的 mRCT 手术治疗的效果。研究过程采用了三步法。研究选择、数据提取和偏倚风险评估由两名独立评审员进行。 R软件（版本4.2.1）和Stata（版本15.1）用于数据分析。结果 我们从 10,633 份出版物中纳入了 15 项随机对照试验（996 名受试者）进行定量分析。就长期和短期手术效果而言，补片增强肩袖修复术（RCR）、富血小板血浆RCR、关节镜减压、桥接重建、关节镜RCR等手术干预措施之间没有统计学上的显着差异。包括血小板白细胞膜、开放式 RCR、微型开放式 RCR、关节镜清创、上囊重建、关节镜下缝合线增强修复、肩峰下球囊垫片和背阔肌肌腱转移。根据算法，概率排名表明补片增强是排名最高的手术干预措施，可实现更好的短期手术结果。 此外，关节镜相关的小型开放式 RCR 被评为实现更好的长期手术效果最高的手术干预措施。结论 根据纳入研究的现有数据，在已报告的 mRCT 干预措施中观察到相似的手术疗效。研究发现补片增强技术有可能实现更好的短期手术结果，这与之前的报告一致。然而，实现长期手术效果的最佳手术干预措施仍然未知。需要更多高质量的研究来评估这些干预措施的有效性和安全性并指导临床实践。