Abstract
BackgroundScientific evidence is not clear regarding the routine use of acromioplasty in the treatment of rotator cuff repair. The aim of this study was to compare clinical outcomes between patients undergoing arthroscopic rotator cuff repair with and without concomitant acromioplasty.MethodsMedline, Cochrane Library, and EMBASE databases were searched to identify eligible studies focused on arthroscopic rotator cuff repair with and without acromioplasty from January 2000 to February 2018. Postoperative functional outcomes, visual analog scale (VAS) for pain and reoperation rate were extracted for systemic analysis.ResultsSix randomized controlled trials (RCTs) and one cohort study (CS), including 651 patients, fulfilled our selection criteria. The results showed a significant difference in American Shoulder and Elbow Surgeons (ASES) score, but not in the Constant score, University of California-Los Angeles (UCLA) score, or Simple Shoulder Test (SST) score, in the treatment of rotator cuff tear with or without concomitant acromioplasty at the final follow-up. In the subgroup analysis, the results showed no significant differences between the two treatments in reoperation rate at the final follow-up or VAS score at 6 months postoperatively and final follow-up, but there was a significant difference in VAS score at 12 months postoperatively in favor of acromioplasty treatment. The evidence quality for each outcome evaluated by the GRADE system was low.ConclusionsIn summary, our present study demonstrated that acromioplasty treatment is significantly superior to nonacromioplasty in shoulder pain relief at 12 months postoperatively and in ASES score improvement at the final follow-up in conjunction with rotator cuff repair. However, these significant differences were not clinically relevant. Thus, there were no differences in shoulder function or pain scores for patients undergoing rotator cuff repair with and without acromioplasty. Further high-quality studies with larger sample sizes and long-term follow-ups are needed to clarify this issue.
Highlights
Armstrong et al.[1] first observed mechanical impingement between the rotator cuff and acromion in shoulder impingement syndrome in 1949
The results showed a significant difference in American Shoulder and Elbow Surgeons (ASES) score, but not in the Constant score, University of California-Los Angeles (UCLA) score, or Simple Shoulder Test (SST) score, in the treatment of rotator cuff tear with or without concomitant acromioplasty at the final follow-up
The results showed no significant differences between the two treatments in reoperation rate at the final follow-up or visual analog scale (VAS) score at 6 months postoperatively and final follow-up, but there was a significant difference in VAS score at 12 months postoperatively in favor of acromioplasty treatment
Summary
Armstrong et al.[1] first observed mechanical impingement between the rotator cuff and acromion in shoulder impingement syndrome in 1949. Neer et al.[2] reported that bony spurs at the anterior and lateral edges of the acromion led to 95% of rotator cuff attritions and tears, and they performed acromioplasty as a concomitant procedure with or without rotator cuff tear, which has recently evolved into an arthroscopic approach[3]. Ellman et al.[6] developed the arthroscopic subacromial decompression (ASD) treatment, which included acromioplasty, coracoacromial ligament (CAL) resection, and subacromial bursectomy, to heighten the subacromial space and protect the integrity of the rotator cuff. 40% of patients undergoing rotator cuff repairs in Finland received arthroscopic acromioplasty[8]. Scientific evidence is not clear regarding the routine use of acromioplasty in the treatment of rotator cuff repair. The aim of this study was to compare clinical outcomes between patients undergoing arthroscopic rotator cuff repair with and without concomitant acromioplasty. Editor: Just Alexander van der Linde, Sint Antonius Ziekenhuis, NETHERLANDS
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