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Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

This systematic review and meta-analysis aimed to evaluate the correlation between increased critical shoulder angle (CSA) and higher retear rates and functional outcomes after arthroscopic rotator cuff repair (ARCR).

Methods

PubMed, Embase, Web of Science, and Cochrane Library databases published before January 2022 were comprehensively searched. Two reviewers independently reviewed the titles and abstracts using the specified criteria. Studies were included if the authors clearly described the correlation between the CSA and rotator cuff repair. Data on patient characteristics, mean CSA, retear rate, and the functional score was pooled from the selected articles. A meta-analysis was performed using Review Manager (RevMan) 5.4.1 software, 2020 (Cochrane Collaboration, Copenhagen, Denmark).

Results

Eleven articles involving 1449 patients from 7 countries were included. The ages of the patients ranged from 45 to 75 years. The follow-up period ranged from 6 to 96 months. The mean CSA was greater in the retear group than in the non-retear group after ARCR (mean difference 2.73°; 95% confidence interval [CI] 0.69–4.77) (p = 0.009). Three studies evaluated the association between increased CSA and the postoperative retear rate. All three studies showed a higher postoperative retear rate in patients with an increased CSA (odds ratio 5.35; 95% CI 2.02–14.15; p = 0.0007). No association was found between CSA and Constant-Murley (Constant), the University of California at Los Angeles (UCLA), or Visual Analog Scale (VAS) scores during the follow-up period of 24–96 months (p > 0.05).

Conclusions

This systematic review and meta-analysis showed that CSA correlates highly with rotator cuff retear after ARCR. In addition, the postoperative retear rate of the rotator cuff increased with increased CSA. CSA appeared to not affect worse functional outcomes in patients after ARCR.

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Availability of data and materials

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors thank the financial support of the Second Hospital of Lanzhou University, “Cuiying Technology Innovation” program, clinical top-notch technology research project, clinical study of autologous osteochondral transplantation for the treatment of recurrent shoulder dislocation in young adults, and the Gansu Provincial Department of Science and Technology, Natural Science Foundation Project, Study on the mechanism of autologous osteochondral transplantation in the treatment of recurrent shoulder dislocation.

Funding

This work was supported by the Second Hospital of Lanzhou University, “Cuiying Technology Innovation” program, clinical top-notch technology research project, CY2019-BJ04, clinical study of autologous osteochondral transplantation for the treatment of recurrent shoulder dislocation in young adults, and the Gansu Provincial Department of Science and Technology, Natural Science Foundation Project, 20JR10RA723, Study on the mechanism of autologous osteochondral transplantation in the treatment of recurrent shoulder dislocation.

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  1. Tao Liu and Mingtao Zhang are co-first authors and have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, People’s Republic of China

    Tao Liu, Mingtao Zhang, Zhitao Yang, Borong Zhang, Jin Jiang & Xiangdong Yun

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Contributions

TL and MZ collected the literature and wrote the article. XY and JJ revised the article. ZY designed the study. BZ prepared figures and tables. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

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Correspondence to Jin Jiang or Xiangdong Yun.

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Liu, T., Zhang, M., Yang, Z. et al. Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 2653–2663 (2023). https://doi.org/10.1007/s00402-022-04640-w

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