Lower Reoperation Rate and Superior Patient-Reported Outcome Following Arthroscopic Rotator Cuff Repair With Concomitant Acromioplasty: An Updated Systematic Review of Randomized Controlled Trials

Abstract

Purpose: To systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trials (RCTs).

Methods: This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full-thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum 12-month follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2. Meta-analysis was conducted for outcomes with at least 3 studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference or odds ratio with 95% confidence intervals (CIs). Primary outcomes included rates of retear and reoperation, whereas secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate.

Results: Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age of 58.4 years, and the following acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. All involved studies reported comparable retear and complication rates between the 2 groups. However, the involved studies indicated a lower reoperation rate, and the pooled data demonstrated a statistically superior improvement in ASES score (weighted mean difference, 3.99; 95% CI, 1.00-6.99; P = .009) in the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison.

Conclusions: Compared with arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications but had a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size.

Level of evidence: Level II, systematic review of Level I and II studies.