Renato Andrade1, Ana Lucinda Correia2, Joni Nunes3, Francisco Xará-Leite4, Emilio Calvo5, João Espregueira-Mendes6, Nuno Sevivas7. 1. Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal; Orthopaedics Department, Centro Hospitalar do Porto, Porto, Portugal. 2. School of Medicine, Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Portugal. 3. Orthopaedics Department, Hospital de Braga, Braga, Portugal. 4. Orthopaedics Department, Centro Hospitalar do Porto, Porto, Portugal. 5. Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain. 6. Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; School of Medicine, Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Portugal. Electronic address: espregueira@dhresearchcentre.com. 7. Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; School of Medicine, Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Portugal; Trofa Saúde Hospital Sr Bonfim - Trofa Saúde Group, Touguinhó, Portugal.
Abstract
PURPOSE: To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear. METHODS: A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale. RESULTS: We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD = 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD = 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD = -7.11, 95% CI -8.32 to -5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio = 2.26, 95% CI 1.38 to 3.70). CONCLUSION: There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.
PURPOSE: To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear. METHODS: A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale. RESULTS: We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD = 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD = 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD = -7.11, 95% CI -8.32 to -5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio = 2.26, 95% CI 1.38 to 3.70). CONCLUSION: There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.