Yeo Mark H X, Seah Shawn J S, Tay Hui Wen, Lie Denny
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
JSES Rev Rep Tech. 2025 Mar 23;5(3):444-452. doi: 10.1016/j.xrrt.2025.02.006. eCollection 2025 Aug.
Vitamin D deficiency is prevalent among the older generation who are also prone to developing degenerative rotator cuff tears. Vitamin D is found to be critical in tendon-to-bone healing and is potentially a modifiable risk factor for arthroscopic rotator cuff repair (RCR) outcomes. However, there are few studies evaluating the effects of vitamin D levels on the latter. This study thus aims to evaluate the relationship between preoperative serum vitamin D levels and rotator cuff tears as well as arthroscopic RCR outcomes.
A systematic search of four databases (PubMed, EMBASE, Scopus, and Cochrane Library) was performed. The inclusion criteria were studies with (a) preoperative serum vitamin D levels, (b) patients who underwent arthroscopic RCR, and (c) preoperative characteristics and postoperative outcomes. Meta-analysis of correlation coefficients was performed to compare the relationship between vitamin D levels and preoperative factors, including (a) fatty degeneration (FD) of supraspinatus and (b) tear size and retraction size, as well as postoperative outcomes, including (a) patient-reported outcome measures and (b) retear rates or failure requiring revision surgery.
Five articles were included with a sample size of 1436. The pooled mean serum vitamin D level was 23.66 ng/ml. Higher vitamin D levels were significantly associated with lower FD (R = -0.24, = .05), but not with tear or retraction size. There was no association between vitamin D levels and postoperative patient-reported outcome measures. There were insufficient studies for meta-analysis of retear rates, but individual results from included studies showed lower rates of retear for groups with sufficient vitamin D levels.
While higher vitamin D levels are associated with lower rates of rotator cuff FD and possible lower retear rates, it does not necessarily lead to better clinical outcomes post-repair. This study's findings do not justify routine testing and supplementation of vitamin D in patients undergoing RCR.
维生素D缺乏在老年人群中普遍存在，而这部分人群也容易发生退行性肩袖撕裂。维生素D在肌腱与骨愈合过程中起着关键作用，并且可能是影响关节镜下肩袖修复（RCR）效果的一个可调节风险因素。然而，很少有研究评估维生素D水平对后者的影响。因此，本研究旨在评估术前血清维生素D水平与肩袖撕裂以及关节镜下RCR效果之间的关系。
对四个数据库（PubMed、EMBASE、Scopus和Cochrane图书馆）进行了系统检索。纳入标准为具备以下条件的研究：（a）术前血清维生素D水平；（b）接受关节镜下RCR的患者；（c）术前特征和术后结果。进行相关系数的荟萃分析，以比较维生素D水平与术前因素之间的关系，这些因素包括：（a）冈上肌脂肪变性（FD）；（b）撕裂大小和回缩大小，以及术后结果，包括：（a）患者报告的结局指标；（b）再撕裂率或需要翻修手术的失败率。
纳入了5篇文章，样本量为1436。血清维生素D水平的合并均值为23.66 ng/ml。较高的维生素D水平与较低的FD显著相关（R = -0.24，P = 0.05），但与撕裂或回缩大小无关。维生素D水平与术后患者报告的结局指标之间没有关联。关于再撕裂率的荟萃分析研究不足，但纳入研究的个体结果显示，维生素D水平充足组的再撕裂率较低。
虽然较高的维生素D水平与较低的肩袖FD发生率以及可能较低的再撕裂率相关，但这并不一定会导致修复后更好的临床结果。本研究结果并不支持对接受RCR的患者进行常规维生素D检测和补充。
