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The Effect of Lipid Disorders on the Risk of Rotator Cuff Disease: A Systematic Review and Meta-Analysis

Lai, Jianyu, MPH1; Gagnier, Joel J., ND, MSc, PhD1,2

doi: 10.2106/JBJS.OA.18.00018
Scientific Articles: PDF Only

Background: Rotator cuff disease has a high prevalence and is associated with shoulder pain and disability. Dyslipidemia might be an intrinsic factor related to the development of the disease as it might increase tendon stiffness and result in tendon problems. The purposes of the present study were (1) to systematically review the association between lipid disorders and the risk of rotator cuff disease and (2) to provide physicians with guidance to prevent rotator cuff disease.

Methods: Six databases were searched through July 6, 2016: MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Eligible studies were assessed for risk of bias and strength of evidence. Meta-analysis was performed for the effect of dyslipidemia on the presence of rotator cuff disease, with the effect being expressed as an odds ratio. The overall effect was estimated, and heterogeneity across studies was expressed with the I2 statistic. We used standard and contour-enhanced funnel plots as well as the Begg and Egger tests to check for publication bias.

Results: Three cross-sectional studies, 1 cohort study, and 3 case-control studies involving 505,852 participants were selected, with 6 of these studies being eligible for meta-analysis. The main-effect meta-analysis yielded a pooled odds ratio of 2.17 (95% confidence interval, 1.46 to 3.23; p < 0.001; I2 = 82.4%), indicating a higher rate of rotator cuff disease in patients with dyslipidemia. The sensitivity analysis was not different from the main-effect analysis. Contour-enhanced funnel plots revealed the possibility of publication bias or other small-study effects.

Conclusions: We found that dyslipidemia was associated with high occurrence of rotator cuff disease. We recommend that physicians examine tendon conditions if their patients have severe dyslipidemia.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence

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1Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan

2Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan

E-mail address for J. Lai:

Investigation performed at the University of Michigan, Ann Arbor, Michigan

Disclosure: No external funds were received in support of this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.