Patient outcomes and return to play after arthroscopic rotator cuff repair in overhead athletes: a systematic review

Filippo Migliorini; Giovanni Asparago; Francesco Cuozzo; Francesco Oliva; Frank Hildebrand; Nicola Maffulli

doi:10.1186/s10195-023-00683-w

Patient outcomes and return to play after arthroscopic rotator cuff repair in overhead athletes: a systematic review

J Orthop Traumatol. 2023 Jan 19;24(1):3. doi: 10.1186/s10195-023-00683-w.

Authors

Filippo Migliorini¹, Giovanni Asparago², Francesco Cuozzo², Francesco Oliva², Frank Hildebrand³, Nicola Maffulli^{2

4

5}

Affiliations

¹ Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
² Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
³ Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
⁴ Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB, Stoke On Trent, England.
⁵ Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG, London, England.

Abstract

Background: Rotator cuff tear injuries in overhead athletes are common and may lead to chronic pain and joint disability, impairing sport participation and leading to premature retirement. The improvement of the patient reported outcome measures (PROMs) was evaluated, as were the time and level of return to sport and the rate of complication in overhead athletes who had undergone arthroscopic rotator cuff repair.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In September 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. All the clinical trials investigating arthroscopic rotator cuff repair in overhead athletes were accessed.

Results: Data from 20 studies were collected. The mean length of the follow-up was 40 months. All PROMs improved at last follow-up: Kerlan-Jobe Orthopaedic Clinic score (P = 0.02), visual analogue scale (P = 0.003), Constant score (P < 0.0001), University of California Los Angeles Shoulder score (P = 0.006) and American Shoulder and Elbow Surgeons' score (P < 0.0001). Elevation also improved (P = 0.004). No difference was found in external and internal rotation (P = 0.2 and P = 0.3, respectively). In total, 75.4% (522 of 692 of patients) were able to return to play within a mean of 6.4 ± 6.0 months. Of 692 patients, 433 (62.5%) were able to return to sport at pre-injury level. Fourteen out of 138 patients (10.1%) underwent a further reoperation. The overall rate of complications was 7.1% (20 of 280).

Conclusion: Arthroscopic reconstruction of the rotator cuff is effective in improving function of the shoulder in overhead athletes, with a rate of return to sport in 75.4% of patients within an average of 6.4 months.

Level of evidence: III, systematic review.

Trial registration: Not applicable.

Keywords: Arthroscopy; Athletes; Complication; Outcomes; Overhead; Repair; Return; Rotator cuff; Shoulder; Treatment.

Publication types

Systematic Review

MeSH terms

Arthroscopy
Athletes
Humans
Range of Motion, Articular
Return to Sport
Rotator Cuff / surgery
Rotator Cuff Injuries* / surgery
Shoulder Joint* / surgery
Treatment Outcome