Elevated Body Mass Index Is Associated with Rotator Cuff Disease: A Systematic Review and Meta-analysis

Purpose The purpose of this study was to analyze the literature regarding obesity, BMI, and RCD. Methods In this Systematic Review and Meta-Analysis, we queried PubMed, Embase, Cochrane, CINAHL, & Science Direct using keywords (August 25th, 2023). Analytic observational studies (cohort, case-control, and cross-sectional studies) with more than 30 participants per comparison group, evaluating the association between obesity and rotator cuff pathology, were eligible for inclusion. Meta-analysis was performed to quantitatively summarize associations between body mass index (BMI) and RCD to report odds ratios and corresponding 95% confidence intervals for regression-based models and BMI mean differences between cases and controls. ROBINS-I tool was used to evaluate risk of bias across all studies in the systematic review. Results After full-text review of 248 articles, 27 presented data on obesity and RCD, and 17 qualified for meta-analysis. Individuals with RCD were 1.21 times (95% CI: 1.10, 1.34) as likely to be overweight and 1.44 times (95% CI: 1.32-1.59) as likely to be obese compared to those without RCD. Each 5 unit increase in BMI was associated with 35% higher odds of having rotator cuff tear (95% CI: 1.06, 1.71). In-depth assessment for risk of bias shows quality of studies varies greatly and highlights outcome heterogeneity, lack of temporality, confounding and selection bias as major concerns for individual studies. Conclusions In this study, we found a positive association between elevated BMI and RCD. Level of Evidence Level III: Systematic review and meta-analysis of Level II-III studies