Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis

ABSTRACT

Background

Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A).

Methods

PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I² <50%) or random (I² ≥50%) effects models were applied to calculate the effect size.

Results

Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15–0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01–0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant.

Conclusions

Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.

KEYWORDS:

• Acromioplasty
• arthroscopic
• rotator cuff tears
• reoperation
• meta-analysis

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception and design of the study: Jinlong Zhao; Statistical analyses: Hetao Huang, Lingfeng Zeng, Jianke Pan; Supervision: Jun Liu and Minghui Luo; Writing e original draft: Jinlong Zhao, Hetao Huang; Writing e-review and editing: Jinlong Zhao, Jun Liu, and Minghui Luo; Jinlong Zhao, Hetao Huang, and Lingfeng Zeng contributed equally to this work; All authors reached an agreement to submit for publication.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2024.2377533

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (No. 82004386, No. 82004383), Administration of Traditional Chinese Medicine of Guangdong Province (No. 20231109), Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine (No. YN2020MS16), Guangdong Basic and Applied Basic Research Foundation (No. 2024A1515012137, No. 2022A1515010385, No. 2022A1515011700, No. 2024A1515012137) and the National key research and development program (2021YFC1712804).