Efetividade das infiltrações subacromiais nas lesões do manguito rotador: revisão sistemática e metanálise.
Data
2023-08-09
Autores
Goulart, Luana Tossolini 
Orientadores
Tamaoki, Marcel Jun Sugawara
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As infiltrações subacromiais são recursos terapêuticos para lesões do manguito rotador, porém ainda não há evidências consistentes da efetividade de cada droga utilizada, tampouco da superioridade de uma opção sobre a outra. Objetivo: analisar a efetividade das substâncias utilizadas nas infiltrações subacromiais para o tratamento de lesões do manguito rotador, considerando melhora da dor e da função do ombro. Método: revisão sistemática e metanálises (pareadas e em rede) de ensaios clínicos randomizados e quasi-randomizados comparando opções de medicamentos e/ou produtos biológicos nas infiltrações subacromiais para lesões do manguito rotador. Resultados: foram incluídos 20 ensaios clínicos randomizados nessa revisão sistemática, totalizando 1479 participantes. As melhores opções de infiltração subacromial, considerando melhora álgica e funcional, avaliada pelo Constant-Murley Score (CMS), no curto prazo, foram o ácido hialurônico (AH) e a combinação de AH com Plasma Rico em Plaquetas (PRP). No médio prazo, por meio de análises diretas, AH, PRP, AH + PRP e corticoide não foram superiores ao placebo considerando Escala Visual Analógica (EVA), porém, por análises indiretas, o AH foi a melhor opção dentre os tratamentos avaliados. Na avaliação funcional pelo American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment score (ASES), o AH associado ao PRP foi superior ao placebo, corticoide e ao PRP isolado. No longo prazo, AH, PRP e corticoide não tiveram melhor desempenho que o placebo na redução da dor. No entanto, em relação a melhora funcional, mensurada pelo CMS e pelo ASES, tanto o AH associado ao PRP, como o PRP e o AH isolados foram superiores ao placebo e o AH com o PRP foi considerado o melhor tratamento. A avaliação funcional mensurada por Simple Shoulder Test (SST), Western Ontario Rotator Cuff (WORC) e The Shoulder Pain and Disability Index (SPADI) não demonstrou diferença entre as opções de infiltração e placebo em nenhum momento. Conclusão: as infiltrações subacromiais de AH com PRP e o AH isolado foram as mais efetivas para dor e função no curto prazo. No médio prazo, nenhuma das opções (AH, PRP, AH + PRP e corticoide) foi melhor que o placebo nas comparações diretas em termos de melhora álgica, porém, na classificação dos tratamentos, o AH ficou em primeiro lugar; a associação de AH com PRP foi a melhor opção para ganho de função. No longo prazo, a infiltração de AH combinado ao PRP resultou em considerável melhora da função, mas nenhuma opção avaliada nesse período foi efetiva para melhora da dor.
Introduction: Subacromial injections are therapeutic resources for rotator cuff injuries; however, there is still no consistent evidence regarding the efficacy of each drug used, nor the superiority of one option over another. Objective: To analyze the effectiveness of substances used in subacromial injections for the treatment of rotator cuff injuries, considering improvements in pain and shoulder function. Method: Systematic review and pairwise and network meta-analyses of randomized and quasi-randomized clinical trials comparing medication and/or biological options in subacromial injections for rotator cuff injuries. Results: The best options for subacromial injections, considering pain and functional improvement, assessed by the Constant-Murley Score (CMS), in the short term, were hyaluronic acid (HA) and the combination of HA with Platelet-Rich Plasma (PRP). In the medium term, through direct analyzes, HA, PRP, HA + PRP and corticoid were not superior to placebo considering Visual Analogue Scale and CMS. However, by indirect analyzes, HA was the best option among the evaluated treatments. In the functional assessment using the American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment score (ASES), HA associated with PRP was superior to placebo, corticosteroids and PRP alone. In the long term, HA, PRP and corticosteroids did not perform better than placebo in reducing pain. However, regarding functional improvement, measured by CMS and ASES, both HA associated with PRP, and PRP and HA alone were superior to placebo and HA with PRP was considered the best treatment. Functional assessment measured by Simple Shoulder Test (SST), Western Ontario Rotator Cuff (WORC) and The Shoulder Pain and Disability Index (SPADI) showed no difference between infiltration and placebo options at any time. Conclusion: The subacromial injections of HA with PRP and HA alone were the most effective for short-term pain and function. In the medium term, none of the options (AH, PRP, AH + PRP and corticoid) was better than placebo in direct comparisons in pain improvement, however, in the classification of treatments, AH was the favorite; the association of HA with PRP was the best option for functional gain. In the long term, HA infiltration combined with PRP resulted in considerable improvement in function, but no option evaluated was effective in improving pain.
Introduction: Subacromial injections are therapeutic resources for rotator cuff injuries; however, there is still no consistent evidence regarding the efficacy of each drug used, nor the superiority of one option over another. Objective: To analyze the effectiveness of substances used in subacromial injections for the treatment of rotator cuff injuries, considering improvements in pain and shoulder function. Method: Systematic review and pairwise and network meta-analyses of randomized and quasi-randomized clinical trials comparing medication and/or biological options in subacromial injections for rotator cuff injuries. Results: The best options for subacromial injections, considering pain and functional improvement, assessed by the Constant-Murley Score (CMS), in the short term, were hyaluronic acid (HA) and the combination of HA with Platelet-Rich Plasma (PRP). In the medium term, through direct analyzes, HA, PRP, HA + PRP and corticoid were not superior to placebo considering Visual Analogue Scale and CMS. However, by indirect analyzes, HA was the best option among the evaluated treatments. In the functional assessment using the American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment score (ASES), HA associated with PRP was superior to placebo, corticosteroids and PRP alone. In the long term, HA, PRP and corticosteroids did not perform better than placebo in reducing pain. However, regarding functional improvement, measured by CMS and ASES, both HA associated with PRP, and PRP and HA alone were superior to placebo and HA with PRP was considered the best treatment. Functional assessment measured by Simple Shoulder Test (SST), Western Ontario Rotator Cuff (WORC) and The Shoulder Pain and Disability Index (SPADI) showed no difference between infiltration and placebo options at any time. Conclusion: The subacromial injections of HA with PRP and HA alone were the most effective for short-term pain and function. In the medium term, none of the options (AH, PRP, AH + PRP and corticoid) was better than placebo in direct comparisons in pain improvement, however, in the classification of treatments, AH was the favorite; the association of HA with PRP was the best option for functional gain. In the long term, HA infiltration combined with PRP resulted in considerable improvement in function, but no option evaluated was effective in improving pain.
Descrição
Citação
GOULART, Luana Tossolini. Efetividade das infiltrações subacromiais nas lesões do manguito rotador: revisão sistemática e metanálise. 2023. 314 f. Dissertação (Mestrado em Cirurgia Translacional) - Escola Paulista de Medicina, Universidade Federal de São Paulo(UNIFESP). São Paulo, 2023