A network meta-analysis of randomized controlled trials of interventions for the treatment of rotator cuff tears

Article type
Gagnier J1, Beyene J2
1University of Michigan, USA
2McMaster University , Canada
Background: Rotator cuff tears are common and increasing in prevalence in our aging population. Rotator cuff tears can be treated through various surgical procedures and rehabilitative programs, many of which have not been compared directly to each other. Using a network meta-analysis allows comparison and facilitates pooling of a diverse population of randomized trials across these approaches in ways that a traditional meta-analysis does not.
Objectives: Our aim is to perform a network meta-analysis using evidence from randomized trials on the relative effect of alternative approaches on recovery in patients who have suffered from a rotator cuff tear. Our secondary study endpoints included a repeat tear.
Methods: A network meta-analysis allows for simultaneous consideration of the relative effectiveness of multiple treatment alternatives. We began with systematic searches of databases (including EMBASE and MEDLINE) and performed hand searches of orthopaedic journals, bibliographies, abstracts from orthopaedic conferences, and orthopaedic textbooks, for all relevant material published from each databases' inception to 2015. Two authors independently screened abstracts and manuscripts and extracted the data, three evaluated the risk of bias in individual studies, and two applied Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria to bodies of evidence. We included all randomized and quasi-randomized trials comparing two (or more) treatment options for rotator cuff tears in predominantly (i.e. > 80%) adult patients. We calculated pooled estimates for all direct comparisons and conducted a network meta-analysis combining direct and indirect evidence for all comparisons.
Results: We included 35 papers comparing two or more interventions for rotator cuff tears. A total of four interventions were tested across trials. We are currently performing the statistical analyses for the network comparisons.
Conclusions: This will be the first network meta-analysis done for clinical trials of rotator cuff tears. These findings will help guide clinical decision making and the design of future randomized studies.