Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients

Miyatake, Katsutoshi; Takeda, Yoshitsugu; Fujii, Koji; Suzue, Naoto; Kawasaki, Yoshiaki; Omichi, Yasuyuki; Yokoyama, Kenji

doi:10.1007/s00167-018-4994-3

Cited by 23 publications

(38 citation statements)

References 37 publications

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“… 2 Several clinical studies have further investigated the relationship between DM and retearing of the rotator cuff tendon. 5 , 9 – 11 , 14 Some clinical studies have reported significantly higher retear rates of repaired rotator cuff tendon in patients with DM. 5 , 10 However, the findings of other studies have not supported DM as a risk factor for tendon retear after arthroscopic rotator cuff repair.…”

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confidence: 99%

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Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Hong

Chang

Kuan

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Retear of a repaired rotator cuff tendon is a major issue for shoulder surgeons. It is possible that diabetes mellitus (DM) is associated with a greater risk of tendon retear after arthroscopic rotator cuff repair. Purpose: To determine whether patients with DM have a higher tendon retear risk after arthroscopic rotator cuff repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Web of Science, PubMed, and Embase databases. Inclusion criteria were articles written in the English language that included patients undergoing arthroscopic rotator cuff repair surgeries, reported the numbers of patients with and those without DM, and reported the number of rotator cuff retears. Data relevant to this study were extracted and statistically analyzed. Random-effects models were used to generate pooled odds ratio estimates and CIs. Results: A total of 160 studies were identified from the initial search, and 5 of them met the inclusion criteria. A total of 1065 patients (207 patients with DM and 858 patients without DM) were included. The pooled results showed that the patients in the DM group had a significantly higher tendon retear risk than did those in the non-DM group (relative risk, 2.25; 95% CI, 1.14-4.45; P = .02). Conclusion: Patients with DM have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without DM.

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confidence: 99%

“… 5 , 10 However, the findings of other studies have not supported DM as a risk factor for tendon retear after arthroscopic rotator cuff repair. 9 , 11 , 14 …”

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confidence: 99%

Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Hong

Chang

Kuan

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…This meta-analysis showed that diabetes was significantly associated with an increased risk of retears in patients after rotator cuff repair, with no heterogeneity found across the included studies. Subgroup analysis of 2 studies 18,51 found that the retear rate was negatively correlated with blood glucose control. In most groups, the diabetic group had worse clinical outcomes after rotator cuff repair.…”

Section: Discussionmentioning

confidence: 99%

“…However, several previous studies have compared the clinical scores of rotator cuff repair between patients with and without diabetes and showed that there were no significant differences between the groups at final followup. 18,20,51 In addition, Clement et al 20 found that the mean improvement in pre-to postoperative outcome scores was significantly greater (P ¼ .0002) in patients without diabetes compared with those with diabetes. This indicates that the impact of diabetes on outcome scores is uncertain.…”

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confidence: 99%

“…Furthermore, other recent studies have examined the preoperative clinical factors that predict retears after arthroscopic rotator cuff repair and have suggested that DM is not a predictive factor for rotator cuff retears. 26,31,37,40,51,55 Until now, the effect of diabetes on outcomes after rotator cuff repair and the effect of sustained hyperglycemia on retear rates have not been well-characterized. A previous meta-analysis has shown that diabetes had a moderate negative effect on outcomes after rotator cuff repair.…”

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Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Yang

Zhang

Ruan

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial. Purpose/Hypothesis: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California–Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model. Results: Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score ( P = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; P = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; P < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; P = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; P < .00001). Conclusion: This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.

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Factors Influencing the Reparability and Healing Rates of Rotator Cuff Tears

Jensen

Taylor

Sánchez-Sotelo

2020

Curr Rev Musculoskelet Med

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Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients

Abstract: III.

Cited by 23 publications

References 37 publications

Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Factors Influencing the Reparability and Healing Rates of Rotator Cuff Tears

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