Retear rates after rotator cuff surgery: a systematic review and meta-analysis

Umile Giuseppe Longo; Arianna Carnevale; Ilaria Piergentili; Alessandra Berton; Vincenzo Candela; Emiliano Schena; Vincenzo Denaro

doi:10.1186/s12891-021-04634-6

Retear rates after rotator cuff surgery: a systematic review and meta-analysis

BMC Musculoskelet Disord. 2021 Aug 31;22(1):749. doi: 10.1186/s12891-021-04634-6.

Authors

Umile Giuseppe Longo¹, Arianna Carnevale^{2

3}, Ilaria Piergentili², Alessandra Berton², Vincenzo Candela², Emiliano Schena³, Vincenzo Denaro²

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy. g.longo@unicampus.it.
² Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.
³ Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy.

Abstract

Background: Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing.

Methods: A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ². The association between retear rate after surgery and patients' age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used.

Results: Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3-6 months follow-up, 16% at 6-12 months follow-up, 21% at 12-24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures).

Conclusions: Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

Keywords: Risk factors; Rotator cuff; Rotator cuff retear; Rotator cuff tear; Timing of retear.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Arthroplasty
Arthroscopy
Humans
Magnetic Resonance Imaging
Rotator Cuff Injuries* / diagnostic imaging
Rotator Cuff Injuries* / epidemiology
Rotator Cuff Injuries* / surgery
Rotator Cuff* / diagnostic imaging
Rotator Cuff* / surgery
Treatment Outcome