Clin Shoulder Elb > Epub ahead of print |
Author contributions
Writing – original draft: MD, OC, RL, PB, MCRH, ZZ, MYF. Writing – review & editing: JAA.
Conflict of interest
JAA would like to disclose royalties from DJO Global, Zimmer-Biomet, Smith and Nephew, Stryker, Globus Medical, Inc.; research support as a PI from: Lima Corporation - Italy, Orthofix, Arthrex, OREF; royalties, financial or material support from Wolters Kluwer; and board member/committee appointments for American Shoulder and Elbow Society, Pacira.
Study | Cohort | Findings |
---|---|---|
Albright et al. (2023) [34] | Population: 672, 640 (336,320 vitamin D deficient) patients undergoing RCR matched patients with vitamin D deficiency | Vitamin D deficiency risk factor for full-thickness RCT (OR, 2.36; 95% CI, 2.17–2.56). Greatest effect in women aged 70–89 (OR, 2.93) and lowest in men between 30 and 49 (OR, 1.87) |
Source: PearlDiver Humana database | Women with RCT and vitamin D deficiency more likely to undergo RCR (OR, 1.37; 95% CI, 1.09–1.74), no difference for male RCT patients with or without vitamin D deficiency | |
Stiffness requiring MUA more likely in vitamin D deficient RCR patients (OR, 1.14; 95% CI, 1.03-1.27) | ||
Similar rates of revision, I&D for vitamin D deficiency patients (P>0.05). | ||
Kim et al. (2023) [23] | 68 Patients (12 vitamin D deficient) undergoing RCR for medium (1–3 cm) full-thickness RCT. | Gene expression |
Source: single institution retrospective study | In vitamin D deficient RCR patients, deltoid VDR expression lower (0.16 vs. 0.34, P<0.05), myoD expression lower (1.09 vs. 2.84, P<0.05), atrogin expression higher (1.05 vs. 0.23 P<0.05). | |
No difference in muscle-atrophy or adipogenic gene expression within supraspinatus tissue samples between vitamin D deficient versus sufficient cohorts. | ||
Inflammation-related genes IL-1B, IL-6 expressed more in vitamin D deficient patients’ deltoid and supraspinatus | ||
No difference in MMP-9, COL1A1, COL3A1, p53, TNF-α gene expression. | ||
Protein expression | ||
In deltoids of vitamin D deficient patients, protein expression of atrogin and IL-6 increased (P<0.05). In the supraspinatus, only IL-6 expression increased with vitamin D deficiency (P<0.05). | ||
Proinflammatory proteins upregulated in vitamin D deficient patients (P<0.05). | ||
Vitamin D deficiency led to expression of muscle atrophy-related proteins in the deltoid (P<0.05), but not the rotator cuff (P>0.05). | ||
Wilde et al. (2023) [36] | 135 Patients (34 with low vitamin D) undergoing RCR | 36% of included RCR patients had low vitamin D. |
Source: Single institution retrospective study | ||
Rhee et al. (2023) [4] | 36 Patients undergoing RCR for full-thickness, small to massive RCTs | 91.7% (33/36) insufficient or deficient vitamin D |
Source: single institution prospective study | Lower serum and tissue vitamin D correlated with preoperative and 1-year postoperative abduction strength (P<0.05). | |
Tissue vitamin D correlate with preoperative, but not postoperative VAS pain, ASES, Constant scores (all P<0.05). | ||
Vitamin D had no relationship with fatty degeneration of the rotator cuff, tear size, retraction (P>0.05). | ||
Muscle fiber cross-sectional area significantly related to tissue, but not serum vitamin D levels (P<0.05). | ||
Liu et al. (2022) [35] | 104 Full-thickness RCT patients (72 with osteoporosis) undergoing RCR. Excluded obese patients. | Vitamin D3 was significantly lower in RCT-OP (16.7 ng/mL) group compared to RCT only (19.6 ng/mL) (P<0.05). |
Source: single institution prospective study | Vitamin D predictive of RCT in osteoporotic patients (P<0.05) | |
Lee et al. (2021) [5] | 176 Patients (78 with low vitamin D) undergoing RCR for full-thickness RCT. | 71% of itamin D insufficient or deficient |
Source: single institution retrospective study | Prevalence of low vitamin D decreased with age (P<0.05). | |
More likely in indoor workers (36.2 vs. 48.3%, P=0.001) | ||
No relationship between sex, smoking status, alcohol consumption and low vitamin D |
Study | Cohort | Main findings |
---|---|---|
Angeline et al. 2014) [12] | Vitamin D deficiency was induced in 28 rats undergoing rotator cuff repair. | Low vitamin D levels affect the early healing after rotator cuff repair, affecting the strength at 2 weeks postoperatively. |
The strength was back to normal at 4 weeks postoperatively despite the histological abnormalities being still present. | ||
Harada et al. (2019) [39] | National Claims Database | A higher rate of postoperative rotator cuff repair revision (P<0.001) and manipulation under anesthesia for stiffness (P=0.035) was seen in the vitamin D deficient cohort. |
229 Patients with low levels of vitamin D and 1,652 patients with normal levels undergoing rotator cuff repair | ||
Cancienne et al. (2019) [40] | PearlDiver database | A higher rate of postoperative rotator cuff repair revision was seen when the normal and deficient group were compared (P=0.007). |
199 Patients had vitamin D deficiency, 322 had vitamin D insufficiency, and 541 did not have low levels of Vitamin D. | ||
All of the patients underwent rotator cuff repair. | ||
O’Donnell et al. (2020) [41] | PearlDiver database | Vitamin D deficiency (OR, 1.18; P<0.001; 95% CI, 1.08–1.28) was shown to increase the risk of revision rotator cuff repair significantly. |
41,467 Patients underwent rotator cuff repair | ||
3,072 underwent revision rotator cuff repair | ||
Chen et al. (2022) [38] | 45 Vitamin D deficient patients and 44 patients with normal levels of vitamin D | Vitamin D deficiency is not correlated with clinical function scores. |
Vitamin D deficiency is associated with the early postoperative pain (P<0.05) and a higher retear rate (P<0.05). | ||
Chen et al. (2022) [42] | 62 Vitamin D deficient patients and 60 patients with normal levels of vitamin D | Vitamin D deficiency is not correlated with clinical function scores or retear rate. |
Vitamin D deficiency is associated with the early postoperative pain (P<0.05) and the quality of rotator cuff healing after surgery (P=0.007). | ||
Ryu et al. (2015) [37] | 80 Vitamin D deficient patients, 8 patients with vitamin D insufficiency, and 3 patients with normal levels of vitamin D | Vitamin D deficiency had no significant impact on postoperative structural integrity and functional outcomes after arthroscopic rotator cuff repair. |
Rhee et al. (2023) [4] | - | Lower serum vitamin D levels at 1 year after surgery |
weakened abduction power while tissue level of vitamin D affected both external rotation and abduction power. | ||
Muscle fiber cross sectional area was lower in the patients with low tissue vitamin D levels but did not correlate with serum vitamin D levels. | ||
Vitamin D levels did not correlate with rotator cuff repair failure |
Study | Cohort | Findings |
---|---|---|
Maier et al. (2014) [54] | Single institution in Germany: 190 patients (109 primary arthroplasty, 50 PJI, 31 aseptic loosening)a) | All patient subgroups showed low 25(OH)D levels (<20 ng/mL) |
PJI (13.29±6.54 ng/mL) patients had lower 25(OH)D levels compared to primary arthroplasty (19.46±9.49 ng/mL, P<0.001) and aseptic loosening (20.52±9.13 ng/mL, P<0.001). | ||
Inkrott et al. (2016) [2] | Single institution in USA: 286 patients (2 HA, 52 aTSA, 164 rTSA) | 93 (43%) 25(OH)D insufficient |
24 (11%) 25(OH)D deficient | ||
BMI >30 kg/m2 lower 25(OH)D levels (31.5±12.1 vs. 36.2±15.7 ng/mL, P<0.01). | ||
Absence vitamin D and calcium supplementation was most significant risk factor for hypovitaminosis D (OR, 8.234; P<0.001). | ||
Smith et al. (2021) [3] | PearlDiver database: 6,696 TSA patients (1,674 25(OH)D deficient, 5,022 age, sex, osteoporosis matched controls) | Higher rate of revision arthroplasty in 25(OH)D deficient compared to controls (2.3% vs. 0.8%; OR, 3.3; P<0.0001) |
Higher risk UTI compared to controls (OR, 1.31; P=0.003) |