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Influence of patient and diagnostic parameters on reported retear rates after arthroscopic rotator cuff repair

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this meta-analysis was to investigate patient and diagnostic parameters influencing the reported rates of recurrent rotator cuff defects after ARCR.

Methods

PubMed, EMBASE, Cochrane Library and Scopus databases were searched for clinical studies on tendon defects after ARCR. Imaging modalities, definitions, detection time points, and other known patient risk factors (patient age, tear severity, grade of fatty infiltration, repair technique) as well as reported defect rates were extracted. A meta-analysis of proportion and meta-regression analysis were used to investigate independent variables influencing reported defect rates.

Results

Of 109 articles reviewed, the diagnostic studies used magnetic resonance imaging (MRI) only (n = 56), ultrasound (US) only (n = 28), MRI or computed tomography (CT) arthrography (CTA, n = 14) or a combination of US, MRI and CTA (n = 11) up to 57 months after ARCR. Definitions of tendon defects were highly variable, including those of partial tendon healing with insufficient thickness defined as either an acceptable outcome (n = 72) or a recurrent defect (n = 22). Reported defect rates demonstrated highly significant heterogeneity between studies and groups. Follow-up time and the evaluation of partial tendon healing were independent factors of the defect rate alongside age, tear severity and repair technique. The type of imaging did not significantly alter defect rates.

Conclusion

A number of specific factors significantly alter the rates of rotator cuff defects reported after ARCR. Standardized protocols in clinical practice are required for consistent diagnosis of recurrent defects after ARCR.

Level of evidence

IV.

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Abbreviations

ARCR:

Arthroscopic rotator cuff repair

CT:

Computed tomography

CTA:

Computed tomographic arthrography

MRI:

Magnetic resonance imaging

US:

Ultrasound

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Acknowledgements

Support for this research was provided by the Schulthess Clinic in Zurich and the University Hospital of Basel in Switzerland. The authors would like to acknowledge the support of Sebastian Kunz for extracting the data from selected articles and Melissa Wilhelmi, PhD, medical writer at the Schulthess Clinic, Zurich, Switzerland, for preparation and editing the manuscript as well as supporting the submission process.

Authors’ contributions

LA was the initiator, project coordinator and data analyst. LA and AMM were involved in the study design. Complementary literature search and data collection were undertaken by AMM and HNA. LA, MF and AMM contributed in the data analysis and interpretation. Preparation of the manuscript was done by AMM and LA. All authors have read, revised, and approved the final manuscript.

Author information

Authors and Affiliations

  1. Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    Andreas M. Müller & Laurent Audigé

  2. Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland

    Andreas M. Müller & Hasan N. Alsayed

  3. Upper Extremities, Schulthess Clinic, Zurich, Switzerland

    Matthias Flury & Laurent Audigé

  4. Department of Orthopaedics, Dammam University, Dammam, Saudi Arabia

    Hasan N. Alsayed

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  1. Andreas M. Müller
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  2. Matthias Flury
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  4. Laurent Audigé
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Correspondence to Laurent Audigé.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Müller, A.M., Flury, M., Alsayed, H.N. et al. Influence of patient and diagnostic parameters on reported retear rates after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 25, 2089–2099 (2017). https://doi.org/10.1007/s00167-017-4481-2

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