Efficacy Of Arthroscopic Distal Clavicle Resection In Rotator Cuff Repair With Acromioclavicular Arthritis:A Meta-analysis

Objective:With the improvement of the medical imaging technology,the rotator cuff tear with acromioclavicular joint arthritis is a very common disease of the shoulder.In recent years the treatment of the the rotator cuff tear with acromioclavicular joint arthritis was reported in the many literatures,which were arthroscopic distal clavicle resection plus rotator cuff repair and only rotator cuff repair.Through collecting the literatures of the rotator cuff tear with acromioclavicular joint arthritis,we systematically review the efficacy of arthroscopic distal clavicle resection in rotator cuff repair with acromioclavicular joint arthritis in order to provide the scientific basis of the treatment of the rotator cuff tear with acromioclavicular joint arthritis.Methods:The Cochrane Library,PubMed,Medline,EMbase,CBM and WanFang Data were searched for studies up to May 2016 concerning the efficacy of arthroscopic distal clavicle resection in rotator cuff repair with acromioclavicular joint arthritis.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies.Next the Meta-analysis was performed using RevMan 5.3 software to compare the efficacy between the patients undergoing arthroscopic distal clavicle resection plus rotator cuff repair and those undergoing simple arthroscopic rotator cuff repair.The randomized control trails and clinical control trials include were evaluated according to Cochrane Handbook for Systematic Reviews of Interventions(Version 5.1)and Methodological Index for Non-randomized Studies(MINORS),respectively.ResultA total of 5 studies(3 RCTs and 2 CCTs)involving 465 patients were included.No statistically significant difference was found between the RCR and DCR plus RCR patients in Visual Analogue Scale(VAS)score [z = 1.01,P=0.31,95% CI(-0.53,0.17)],Constant score[z = 0.50,P=0.62,95% CI(-1.36,2.28)],American Shoulder and Elbow Surgeons(ASES)score[z = 0.90,P=0.37,95% CI(-3.02,8.17)],shoulder range of motion(ROM)[z=0.25,P=0.80,95% CI(-3.36,2.60)],postoperative acromioclavicular pain[z = 1.21,P=0.23,95% CI(0.69,4.76)] or rotator cuff retear[z =0.52,P=0.60,95% CI(0.33,1.89)](P>0.05).The three RCTs showed moderate bias risk and the two CCTs scored 21 MINORS points.Conclusions:Since current evidence shows no advantages of arthroscopic DCR plus RCR over only RCR in rotator cuff repair with acromioclavicular arthritis in VAS score,Constant score,ASES score,shoulder ROM,postoperative acromioclavicular pain or rotator cuff retear,arthroscopic DCR should not be recommended for routine use in clinic.