Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials.

Lei Song,Peng Zhang,Wen-Liang Wang,Ling Miao

doi:10.1186/s40064-016-2311-5

Abstract

PurposeTo conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to determine the benefits of concomitant acromioplasty in repairing full-thickness rotator cuff tears.MethodsLiterature search was performed in PubMed, Embase and the Cochrane Library from databases inception through February 2016 to identify RCTs evaluating the efficacy of performing a concomitant acromioplasty. Statistical heterogeneity among studies was quantitatively evaluated by I-squared index (I2) and trial sequential analysis (TSA) was applied to control random errors.ResultsFive RCTs totaling 523 patients were included. There was no statistically significant difference in Constant score (WMD = 1.00; 95 % CI −4.40 to 6.41; P = 0.72), University of California-Los Angeles (UCLA) score (WMD = 0.48; 95 % CI −0.79 to 1.76; P = 0.46), visual analog scale (VAS) for pain (WMD = −0.23; 95 % CI −0.58 to 0.11; P = 0.19) and re-tear rate (RR = 0.46; 95 % CI 0.14 to 1.53; P = 0.21) between acromioplasty group and the nonacromioplasty group. However, it was found to be related to a greater increase in American Shoulder and Elbow Surgeons (ASES) score (WMD = 3.02; 95 % CI 0.24 to 5.80; P = 0.03). Unfortunately, this difference was not reinforced by subsequent TSA. In addition, subgroup analysis showed no substantial difference of ASES score in patients with type-1 (WMD = −8.21; 95 % CI −23.55 to 7.14; P = 0.29), type-2 (WMD = 0.97; 95 % CI −5.10 to 7.05; P = 0.75), or type-3 (WMD = 2.32; 95 % CI −9.96 to 14.61; P = 0.71) acromion.ConclusionsA significant higher ASES score was observed during the comparison despite lacking reinforcement by TSA. No difference was found in Constant score, UCLA score, VAS, re-tear rate and subgroup analysis did not confirm the impact of acromion type on eventual therapeutic outcome. Future studies with large number of participants, long-term follow-ups, data of patient-reported outcomes and stratification for acromion type are of the essence for demonstrating whether functional or structural differences exist in patients undergoing arthroscopic repair of full-thickness rotator cuff tears with or without acromioplasty.

Highlights

Since initially presented its successful utilization in treating chronic impingement syndrome by Neer (1972), open anterior acromioplasty had brought numerous preferable clinical outcomes (McShane et al 1987; Hawkins et al 1988; Bigliani et al 1989)
Primary outcome: functional scores Of all the functional scores described in the five included studies (Table 1), only four patient-reported outcomes (ASES score, Constant score, University of California-Los Angeles (UCLA) score and visual analog scale (VAS)) could respectively be pooled to perform data analysis
A meta-analysis of these trials showed that concomitant acromioplasty was related to a greater increase in ASES score compared with nonacromioplasty among patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff (WMD = 3.02; 95 % CI 0.24–5.80; P = 0.03)

Summary

Methods

Literature search was performed in PubMed, Embase and the Cochrane Library from databases inception through February 2016 to identify RCTs evaluating the efficacy of performing a concomitant acromioplasty. Statistical heterogeneity among studies was quantitatively evaluated by I-squared index (I2) and trial sequential analysis (TSA) was applied to control random errors

Results

Conclusions

Background

Discussion

Conclusion