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

Purpose: To 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. 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 (I-2) and trial sequential analysis (TSA) was applied to control random errors. Results: Five 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. Conclusions: A 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.