Perioperative glycemic control reduces the risk of retear in diabetic patients following arthroscopic rotator cuff repair: A meta-analysis

Background: Previous studies have associated diabetes with reduced shoulder motion, increased pain, and higher postoperative retear risk after arthroscopic rotator cuff repair (ARCR). However, the impact of glycemic control, measured by hemoglobin A1c (HbA1c) levels, on retear and revision rates after ARCR in diabetic patients remains unclear. Methods: This systematic review was conducted using the PubMed, Cochrane Library, Web of Science, and Embase databases according to the preferred reporting conventions for systematic reviews and meta-analyses. Only studies that compared retears and revisions in ARCR patients with documented HbA1c levels between controlled and uncontrolled diabetes groups were included. Relevant data were extracted and analyzed using STATA software. The methodological index for nonrandomized studies was employed to assess the risk of bias in the selected studies. Additionally, heterogeneity tests and sensitivity analyses were conducted to evaluate potential heterogeneity within the samples, and publication bias was also detected. Results: Six studies (4395 patients), including five retrospective cohort studies and one case-control study, were included. Four of these studies assessed retears involving 253 patients. Lower HbA1c levels, indicating better glycemic control, were significantly associated with reduced retear rates after ARCR in diabetic patients (P = 0.000; odds ratio = 0.242, 95 % confidence interval: 0.128-0.454; I2 = 25 %). For revision evaluations, two studies, with a total of 4142 patients, found no significant difference in rates between controlled and uncontrolled diabetes groups, and no publication bias was detected. Conclusion: Following ARCR in diabetic patients, effective glycemic control significantly reduces retear rates without affecting revisions, and maintaining glycemic control in the postoperative period may contribute to rotator cuff healing. (c) 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.