Title:The Influence of Diabetes Mellitus on Rotator Cuff Repair: A Systematic Review and Meta-Analysis
Volume: 24
Issue: 7
Author(s): Xiaomin Lu*, He Sun*, YiSheng Xu and Xuewei Cao
Affiliation:
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou,China
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou,China
Keywords:
Diabetes mellitus, rotator cuff tendinopathy, surgical complications, clinical outcomes, meta-analysis.
Abstract:
Background: Clinical outcomes after rotator cuff repair associated with diabetes
mellitus (DM) are generally favorable, but no study has attempted to establish the influence of DM
on outcomes after rotator cuff repair.
Purpose: To conduct a meta-analysis of clinical studies evaluating patient outcomes between
people with DM and people without DM after rotator cuff repair.
Study Design: Meta-analysis.
Methods: A literature search of the Embase, PubMed, and Cochrane Library databases was
performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after
rotator cuff repair comparing people with DM and people without DM were included. Statistical
analysis was performed with RevMan (v 5.3.3).
Results: Nine clinical studies that met the inclusion criteria were identified and included a total of
314 patients treated with DM and 1092 patients without DM. The failure rate was significantly
higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95%
CI, 1.69–3.37; p < 0.001). The postoperative retear rate and showed a significant difference
between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57–3.71; p<0.001). The DM
group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and
25.23%; OR: 2.14; 95% CI, 1.69–3.37; p=0.01).Postoperative Range of motion(ROM) at 12
months after surgery show a significant difference in the range of external rotation between two
groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001). The preoperative Japanese Orthopaedic
Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a
significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the
pre- and post-operative muscle strength, the pre- and post-operative visual analog scale (VAS)
show significant difference between the DM and Non-DM group(p<0.001).
The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative
ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward
flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of
California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant
difference between the two groups.
Conclusion: This meta-analysis indicates that DM may be relative to a higher rate of shoulder
retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after
cuff repair, compared to patients without DM.
