Does acromioplasty enhance arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized trials.

Abstract

Background: Acromioplasty is frequently performed during arthroscopic rotator cuff repair (ARCR) to address subacromial impingement, though its clinical value remains debated. This meta-analysis examines whether acromioplasty improves functional outcomes, pain relief, or re-tear rates in patients undergoing ARCR for full-thickness rotator cuff tears.

Methods: A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify randomized controlled trials from 2011 to 2023. Six randomised controlled trials comparing ARCR with and without acromioplasty were included. Primary outcomes included functional scores of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff Index, University of California, Los Angeles scores), pain levels (visual analog scale [VAS]), and re-tear rates. Data were pooled using a random-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Across 574 patients, both groups demonstrated improvement in functional outcomes. The acromioplasty group showed a modest advantage (e.g., ASES score: mean difference, 2.93), but these gains did not exceed the minimal clinically important difference. There were no significant differences in pain relief (as measured by VAS) or re-tear rates between groups. The risk of bias was moderate in some trials due to a lack of blinding. GRADE assessment rated evidence as high for ASES scores and moderate for other outcomes.

Conclusions: Acromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. Given these findings, the routine use of acromioplasty in ARCR is not supported; however, select patients may benefit based on individual anatomical or clinical factors. Level of evidence: I.