{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:53:57Z","timestamp":1791370437543,"version":"4.3.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The clinical value of acromioplasty (AC) combined with arthroscopic rotator cuff repair (RCR) remains controversial. This study evaluates the associations and heterogeneity of treatment response for concomitant AC during arthroscopic RCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 734 patients (220 AC, 514 RCR-only). Propensity scores were estimated via a SuperLearner ensemble, followed by inverse probability of treatment weighting to balance covariates. Structural healing, functional outcomes (American Society of Shoulder and Elbow Surgeons and Constant\u2013Murley Shoulder scores), and re-tear events were assessed at 12\u00a0months. Doubly robust machine-learning approaches (DR-learner, causal forest, Bayesian additive regression trees) were employed to estimate the average and individual treatment effects. Shapley Additive Explanations (SHAP) were used to improve model interpretability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Acromioplasty was associated with improved structural healing (risk difference: \u22127.8%; 95% confidence interval [CI], \u221211.9% to \u22123.6%; number needed to treat [NNT] \u2248 13). Weighted Kaplan-Meier analysis showed significantly lower cumulative re-tear incidence at 60\u00a0months (AC: 45.9% vs. RCR-only: 80.0%; hazard ratio: 0.41; 95% CI: 0.33 to 0.51; p &amp;lt; 0.001). Functional scores were significantly higher with AC (\u0394ASES = 7.9; \u0394Constant = 7.5; both p &amp;lt; 0.001), although these differences did not exceed established minimal clinically important difference thresholds. Considerable treatment heterogeneity was identified: patients with a high critical shoulder angle (CSA) (&amp;gt;35\u00b0) and older age (&amp;gt;62\u00a0years) showed the strongest associations with potential benefits. The SHAP analysis identified age, body mass index, tear size, and CSA as key factors influencing outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Concomitant AC is associated with enhanced structural healing and long-term durability in arthroscopic RCR. Although functional scores were statistically higher in the AC group, the differences did not exceed established MCID thresholds, indicating limited clinical significance for functional outcomes. Significant treatment heterogeneity highlights the importance of individualised surgical strategies, particularly favouring patients with high CSAs and of older age.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1840528","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:27:17Z","timestamp":1791368837000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Concomitant acromioplasty is associated with enhanced structural healing, long-term durability, and functional outcomes in arthroscopic rotator cuff repair: a retrospective propensity score and causal machine-learning analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Yucheng","family":"Song","sequence":"first","affiliation":[{"name":"Shoulder Research Institute, Academy of Orthopedics Guangdong Province","place":["Guangzhou, China"]},{"name":"Department of Shoulder and Elbow Surgery, Southern Medical University Third Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Shoulder Research Institute, Academy of Orthopedics Guangdong Province","place":["Guangzhou, China"]},{"name":"Department of Shoulder and Elbow Surgery, Southern Medical University Third Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Liu","sequence":"additional","affiliation":[{"name":"Shoulder Research Institute, Academy of Orthopedics Guangdong Province","place":["Guangzhou, China"]},{"name":"Department of Shoulder and Elbow Surgery, Southern Medical University Third Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Wang","sequence":"additional","affiliation":[{"name":"Shoulder Research Institute, Academy of Orthopedics Guangdong Province","place":["Guangzhou, China"]},{"name":"Department of Shoulder and Elbow Surgery, Southern Medical University Third Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s00402-025-05901-0","article-title":"Efficacy of arthroscopic assisted lower trapezius tendon transfer versus reverse shoulder arthroplasty in patients with posterosuperior irreparable rotator cuff tear without arthritis: retrospective propensity score matching study","volume":"145","author":"Baek","year":"2025","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1097\/CORR.0000000000002520","article-title":"High acromial slope and low acromiohumeral distance increase the risk of retear of the supraspinatus tendon after repair","volume":"481","author":"Caffard","year":"2023","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"138666","DOI":"10.52965\/001c.138666","article-title":"Acromioplasty: a historical perspective","volume":"17","author":"Chow","year":"2025","journal-title":"Orthop. Rev. (Pavia)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2483","DOI":"10.1177\/03635465241302797","article-title":"The statistical fragility of functional outcomes for arthroscopic rotator cuff repair with and without acromioplasty: a systematic review and meta-analysis","volume":"53","author":"Clark","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"26350254231188981","DOI":"10.1177\/26350254231188981","article-title":"Anchorless transosseous rotator cuff repair: a technical note","volume":"4","author":"Cohn","year":"2024","journal-title":"Video J. Sports Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1177\/03635465231182993","article-title":"A systematic review and meta-analysis of risk factors for the increased incidence of revision surgery after arthroscopic rotator cuff repair","volume":"52","author":"Darbandi","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2325967118792001","DOI":"10.1177\/2325967118792001","article-title":"Short-term outcomes of arthroscopic debridement and selected acromioplasty of Bursal-vs articular-sided partial-thickness rotator cuff tears of less than 50","volume":"6","author":"Dwyer","year":"2018","journal-title":"Orthop. J. Sports Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2325967124S00115","DOI":"10.1177\/2325967124S00115","article-title":"Poster 146: higher reoperation rates following primary rotator cuff repair in patients screening positive for depression","volume":"12","author":"Gaudiani","year":"2024","journal-title":"Orthop. J. Sports Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.arthro.2017.08.255","article-title":"Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: a safe adjunct to rotator cuff repair","volume":"34","author":"Gerber","year":"2018","journal-title":"Arthroscopy"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1002\/psp4.12715","article-title":"Heterogeneous treatment effect analysis based on machine-learning methodology","volume":"10","author":"Gong","year":"2021","journal-title":"CPT Pharmacometrics Syst. Pharmacol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"23259671231190335","DOI":"10.1177\/23259671231190335","article-title":"Arthroscopic biological augmentation with subacromial Bursa for bursal-sided partial-thickness rotator cuff tears","volume":"11","author":"G\u00fcler","year":"2023","journal-title":"Orthop. J. Sports Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/CORR.0000000000003247","article-title":"No short-term clinical benefit to bovine collagen implant augmentation in primary rotator cuff repair: a matched retrospective study","volume":"483","author":"Haft","year":"2025","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"4762","DOI":"10.1016\/j.arthro.2025.05.015","article-title":"Perioperative leukocyte-poor platelet-rich plasma associated with reduced risk of retear after arthroscopic rotator cuff repairs: a systematic review and meta-analysis of randomized controlled trials","volume":"41","author":"Hovland","year":"2025","journal-title":"Arthroscopy"},{"key":"B14","doi-asserted-by":"publisher","first-page":"04025004","DOI":"10.1061\/jccee5.cpeng-5980","article-title":"Exploring the efficacy of artificial intelligence in speed prediction: explainable machine-learning approach","volume":"39","author":"Jain","year":"2025","journal-title":"J. Comput. Civ. Eng."},{"key":"B15","doi-asserted-by":"publisher","first-page":"117689","DOI":"10.1016\/j.eswa.2022.117689","article-title":"A novel short receptive field based dilated causal convolutional network integrated with bidirectional LSTM for short-term load forecasting","volume":"205","author":"Javed","year":"2022","journal-title":"Expert Syst. Appl."},{"key":"B16","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1186\/s12891-018-2294-1","article-title":"Influence of the site of acromioplasty on reduction of the critical shoulder angle (CSA) - an anatomical study","volume":"19","author":"Kaiser","year":"2018","journal-title":"BMC Musculoskelet. Disord."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.1016\/j.jse.2013.05.002","article-title":"Investigating minimal clinically important difference for constant score in patients undergoing rotator cuff surgery","volume":"22","author":"Kukkonen","year":"2013","journal-title":"J. Shoulder Elb. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.2106\/JBJS.K.00488","article-title":"Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: a multicenter, randomized controlled trial","volume":"93","author":"MacDonald","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"B19","doi-asserted-by":"publisher","first-page":"102894","DOI":"10.1016\/j.otsr.2021.102894","article-title":"Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair","volume":"108","author":"Malavolta","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.3233\/BMR-210358","article-title":"The effect of postoperative sling immobilization and early mobilization on clinical and functional outcomes after arthroscopic rotator cuff repair: a propensity score-matched analysis","volume":"35","author":"Misir","year":"2022","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/j.jse.2024.08.029","article-title":"Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2-year follow-up in 74 at-risk sports patients","volume":"34","author":"Moore","year":"2025","journal-title":"J. Shoulder Elb. Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jseint.2023.11.002","article-title":"Impact of critical shoulder angle in shoulder pathology: a current concepts review","volume":"8","author":"Oladimeji","year":"2023","journal-title":"JSES Int."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3881","DOI":"10.1007\/s00167-019-05433-2","article-title":"The effect of concomitant coracohumeral ligament release in arthroscopic rotator cuff repair to prevent postoperative stiffness: a retrospective comparative study","volume":"27","author":"Park","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.jseint.2024.09.018","article-title":"Patients with fibromyalgia have increased risk of 90-day postoperative adverse events following arthroscopic rotator cuff repair","volume":"9","author":"Rancu","year":"2024","journal-title":"JSES Int."},{"key":"B25","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jseint.2023.08.008","article-title":"Analysis of factors associated with patient-reported outcome (PRO) score completion rate one year after shoulder surgeries","volume":"8","author":"Romeo","year":"2023","journal-title":"JSES Int."},{"key":"B26","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.arthro.2011.10.016","article-title":"The efficacy of acromioplasty in the arthroscopic repair of small-to medium-sized rotator cuff tears without acromial spur: prospective comparative study","volume":"28","author":"Shin","year":"2012","journal-title":"Arthroscopy"},{"key":"B27","doi-asserted-by":"publisher","first-page":"103697","DOI":"10.1016\/j.ebiom.2021.103697","article-title":"Comparison of machine learning clustering algorithms for detecting heterogeneity of treatment effect in acute respiratory distress syndrome: a secondary analysis of three randomised controlled trials","volume":"74","author":"Sinha","year":"2021","journal-title":"EBioMedicine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12871-020-01036-4","article-title":"Cannabis use is associated with a small increase in the risk of postoperative nausea and vomiting: a retrospective machine-learning causal analysis","volume":"20","author":"Suhre","year":"2020","journal-title":"BMC Anesthesiol."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.23.00188","article-title":"Rotator cuff tears to shoulder instability: the relationship between acromial morphology and shoulder pathology","volume":"12","author":"Testa","year":"2024","journal-title":"JBJS Rev."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2960","DOI":"10.1016\/j.arthro.2022.06.018","article-title":"Anterolateral acromioplasty does not change the critical shoulder angle and acromion index in a clinically relevant amount","volume":"38","author":"Thiesemann","year":"2022","journal-title":"Arthroscopy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/j.jseint.2024.05.009","article-title":"Predictability and functional impact of lateral acromioplasty using preoperative 2D planning on the correction of the critical shoulder angle (CSA) in patients with rotator cuff repair","volume":"8","author":"Toro","year":"2024","journal-title":"JSES Int."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1016\/j.arthro.2023.12.026","article-title":"Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older","volume":"40","author":"Ueda","year":"2024","journal-title":"Arthroscopy"},{"key":"B33","doi-asserted-by":"publisher","first-page":"9005","DOI":"10.1109\/TNNLS.2024.3412753","article-title":"GRACE: unveiling gene regulatory networks with causal mechanistic graph neural networks in single-cell RNA-sequencing data","volume":"36","author":"Wang","year":"2025","journal-title":"IEEE Trans. Neural Netw. Learn Syst."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1177\/03635465241267022","article-title":"Risk factors for recurrent instability after arthroscopic bankart repair in pediatric and adolescent patients: a systematic review","volume":"53","author":"Warner","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1177\/0964528419895529","article-title":"Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score-matched cohort study","volume":"38","author":"Yang","year":"2020","journal-title":"Acupunct. Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1016\/j.arthro.2024.05.026","article-title":"Lower reoperation rate and superior patient-reported outcome following arthroscopic rotator cuff repair with concomitant acromioplasty: an updated systematic review of randomized controlled trials","volume":"41","author":"Yang","year":"2025","journal-title":"Arthroscopy"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e1224","DOI":"10.1016\/j.jse.2025.03.011","article-title":"Prevalence and risk factors for the development of glenohumeral osteoarthritis following arthroscopic bankart repair: a systematic review and meta-analysis of studies with minimum 5-years follow-up","volume":"34","author":"Yeo","year":"2025","journal-title":"J. Shoulder Elb. Surg."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1840528\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:27:18Z","timestamp":1791368838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1840528\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":37,"alternative-id":["10.3389\/fbioe.2026.1840528"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1840528","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1840528"}}