title: Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials.
abstract: OBJECTIVE
  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.
authors.affiliation: Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, No. 220, Chenglin Road, Hedong District, Tianjin, 300162 China.
authors.forename: Lei
authors.initials: L
authors.lastname: Song
authors.affiliation: Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, No. 220, Chenglin Road, Hedong District, Tianjin, 300162 China.
authors.forename: Ling
authors.initials: L
authors.lastname: Miao
authors.affiliation: Department of Orthopaedic Center, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, No. 220, Chenglin Road, Hedong District, Tianjin, 300162 China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Center, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, No. 220, Chenglin Road, Hedong District, Tianjin, 300162 China.
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Wang
keywords: Acromioplasty; Arthroscopic; Meta-analysis; Randomized controlled trials (RCTs); Repair; Rotator cuff; Subacromial decompression (SAD)