Abstract
Purpose
To identify prognostic factors significantly associated with rotator cuff repair outcome and define the strength of these associations.
Methods
Search was performed using electronic databases. Studies reporting prognostic factors affecting rotator cuff repair outcome were included. Primary outcomes were: structural integrity, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, and Constant score. Each other outcome was considered as secondary outcome. Descriptive statistics was used. When possible, meta-analyses were performed. Methodological quality was assessed using the Quality In Prognosis Studies Tool. A best evidence synthesis was performed using the Grading of Recommendations Assessment, Development and Evaluation framework adapted to prognostic studies.
Results
Sixty-four studies were included. Methodological quality was high only for twelve studies. The overall quality of evidence was low to very low. Meta-analyses were possible only for seven studies. Older age and larger tears size were found to affect retear risk. Results were controversial for fatty infiltration, acromioclavicular joint or biceps procedures, acromiohumeral distance, delamination of tendon edges, musculotendinous junction position, number of tendons involved, and tendon length, quality and retraction. Baseline scores and workers compensation claim predicted functional outcomes. Subjective outcome was also affected by patient’s expectations.
Conclusions
Despite the large number of outcomes and prognostic factors evaluated by a relative small number of studies, almost not prognostic in design, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair. Moreover, the low methodological quality of the included studies and, subsequently, the low quality of evidence, seriously affected the strength of recommendation of the present review. Based on data available, retear risk is mainly affected by older age and larger tears size. Baseline scores and work compensation claim are the most significant predictors for functional outcomes.
Level of evidence
Systematic review of level I–IV prognostic studies, Level IV.
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References
Ames JB, Horan MP, Van der Meijden OAJ, Leake MJ, Millett PJ (2012) Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am 94:1862–1869
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406
Balyk R, Luciak-Corea C, Otto D, Baysal D, Beaupre L (2008) Do outcomes differ after rotator cuff repair for patients receiving workers’ compensation? Clin Orthop Relat Res 466:3025–3033
Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 15:290–299
Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal? J Bone Joint Surg Am 87:1229–1240
Boissonnault WG, Badke MB, Wooden MJ, Ekedahl S, Fly K (2007) Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comorbidities. J Orthop Sports Phys Ther 37:312–319
Charousset C, Grimberg J, Duranthon LD, Bellaïche L, Petrover D, Kalra K (2008) The time for functional recovery after arthroscopic rotator cuff repair: correlation with tendon healing controlled by computed tomography arthrography. Arthroscopy 24:25–33
Cho NS, Rhee YG (2009) The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Relat Res Surg 1:96–104
Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41:1674–1683
Chung SW, Oh JH, Gong HS, Kim JY, Kim SH (2011) Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med 39:2099–2107
Chung SW, Park JS, Kim SH, Shin SH, Oh JH (2012) Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors. Am J Sports Med 40:631–639
DeHaan AM, Axelrad TW, Kaye E, Silvestri L, Puskas B, Foster TE (2012) Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review. Am J Sports Med 40:1176–1185
Demirors H, Circi E, Akgun RC, Tarhan NC, Cetin N, Akpinar S, Tuncay IC (2010) Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears. Int Orthop 34:531–536
Di Paola J (2013) Limited physical therapy utilization protocol does not affect impairment and disability in Workers’ Compensation patients after rotator cuff repair: a short-term follow-up study. J Shoulder Elbow Surg 22:409–417
Djahangiri A, Cozzolino A, Zanetti M, Helmy N, Rufibach K, Jost B, Gerber C (2013) Outcome of single-tendon rotator cuff repair in patients aged older than 65 years. J Shoulder Elbow Surg 22:45–51
Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68:1136–1144
Fermont AJM, Wolterbeek N, Wessel RN, Baeyens J-P, de Bie RA (2014) Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review. J Orthop Sports Phys Ther 44:153–163
Flurin P-H, Hardy P, Abadie P, Boileau P, Collin P, Deranlot J, Desmoineaux P, Duport M, Essig J, Godenèche A, Joudet T, Kany J, Sommaire C, Thelu C-E, Valenti P, French Arthroscopy Society (SFA) (2013) Arthroscopic repair of the rotator cuff: prospective study of tendon healing after 70 years of age in 145 patients. Orthop Traumatol Surg Res 99:S379–S384
Flurin P-H, Landreau P, Gregory T, Boileau P, Lafosse L, Guillo S, Kempf J-F, Toussaint B, Courage O, Brassart N, Laprelle E, Charousset C, Steyer A, Wolf EM (2007) Cuff integrity after arthroscopic rotator cuff repair: correlation with clinical results in 576 cases. Arthrosc J Arthrosc Relat Surg 23:340–346
Genuario JW, Donegan RP, Hamman D, Bell J-E, Boublik M, Schlegel T, Tosteson ANA (2012) The cost-effectiveness of single-row compared with double-row arthroscopic rotator cuff repair. J Bone Joint Surg Am 94:1369–1377
Gladstone JN, Bishop JY, Lo IKY, Flatow EL (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35:719–728
Goutallier D, Postel JM, Van Driessche S, Godefroy D, Radier C (2006) Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: results in a prospective series with limited fatty muscular degeneration. J Shoulder Elbow Surg 15:164–172
Goutallier D, Postel J-M, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554
Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C (2009) Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy 25:4–12
Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD, Arthroscopic Rotator Cuff Registry HSS (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II–prognostic factors for clinical and radiographic outcomes. J Shoulder Elbow Surg 20:941–946
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158:280–286
Henn RF, Kang L, Tashjian RZ, Green A (2007) Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 89:1913–1919
Henn RF, Tashjian RZ, Kang L, Green A (2008) Patients with workers’ compensation claims have worse outcomes after rotator cuff repair. J Bone Joint Surg Am 90:2105–2113
Huguet A, Hayden JA, Stinson J, McGrath PJ, Chambers CT, Tougas ME, Wozney L (2013) Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework. Syst Rev 2:71
Iannotti JP, Bernot MP, Kuhlman JR, Kelley MJ, Williams GR (1996) Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears. J Shoulder Elbow Surg 5:449–457
Jo CH, Shin JS (2013) Cross-sectional area of the supraspinatus muscle after rotator cuff repair: an anatomic measure of outcome. J Bone Joint Surg Am 95:1785–1791
Kim YK, Moon SH, Cho SH (2013) Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med 41:2270–2277
Kluger R, Bock P, Mittlböck M, Krampla W, Engel A (2011) Long-term survivorship of rotator cuff repairs using ultrasound and magnetic resonance imaging analysis. Am J Sports Med 39:2071–2081
Koh KH, Lim TK, Park YE, Lee SW, Park WH, Yoo JC (2014) Preoperative factors affecting footprint coverage in rotator cuff repair. Am J Sports Med 42:869–876
Lafosse L, Brozska R, Toussaint B, Gobezie R (2007) The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 89:1533–1541
Lam F, Mok D (2004) Open repair of massive rotator cuff tears in patients aged sixty-five years or over: is it worthwhile? J Shoulder Elbow Surg 13:517–521
Lambers Heerspink FO, Dorrestijn O, van Raay JJAM, Diercks RL (2014) Specific patient-related prognostic factors for rotator cuff repair: a systematic review. J Shoulder Elbow Surg 23:1073–1080
Lapner PC, Su Y, Simon D, El-Fatori S, Lopez-Vidriero E (2010) Does the upward migration index predict function and quality of life in arthroscopic rotator cuff repair? Clin Orthop Relat Res 468:3063–3069
Lapner PLC, Sabri E, Rakhra K, McRae S, Leiter J, Bell K, Macdonald P (2012) A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 94:1249–1257
Lee KW, Seo DW, Bae KW, Choy WS (2013) Clinical and radiological evaluation after arthroscopic rotator cuff repair using suture bridge technique. Clin Orthop Relat Res Surg 5:306–313
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–34
Lichtenberg S, Liem D, Magosch P, Habermeyer P (2006) Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study. Knee Surg Sports Traumatol Arthrosc 14:1200–1206
Lindley K, Jones GL (2010) Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ) 39:592–600
Mallon WJ, Misamore G, Snead DS, Denton P (2004) The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg 13:129–132
Mather RC, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J, Williams G (2013) The societal and economic value of rotator cuff repair. J Bone Joint Surg Am 95:1993–2000
McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA (2014) Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. doi:10.1177/0363546514529644
Melean P, Lichtenberg S, Montoya F, Riedmann S, Magosch P, Habermeyer P (2013) The acromial index is not predictive for failed rotator cuff repair. Int Orthop 37:2173–2179
Mellado JM, Calmet J, Olona M, Ballabriga J, Camins A, Pérez del Palomar L, Giné J (2006) MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture. Eur Radiol 16:2186–2196
Mellado JM, Calmet J, Olona M, Esteve C, Camins A, Pérez Del Palomar L, Giné J, Saurí A (2005) Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol 184:1456–1463
Meyer DC, Wieser K, Farshad M, Gerber C (2012) Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med 40:2242–2247
Milano G, Saccomanno MF, Careri S, Taccardo G, De Vitis R, Fabbriciani C (2013) Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: a prospective randomized study. Arthroscopy 29:802–810
Namdari S, Baldwin K, Glaser D, Green A (2010) Does obesity affect early outcome of rotator cuff repair? J Shoulder Elbow Surg 19:1250–1255
Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD (2009) Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elbow Surg 18:13–20
Nho SJ, Shindle MK, Adler RS, Warren RF, Altchek DW, MacGillivray JD (2009) Prospective analysis of arthroscopic rotator cuff repair: subgroup analysis. J Shoulder Elbow Surg 18:697–704
Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS (2009) Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy 25:30–39
Oh JH, Kim SH, Kang JY, Oh CH, Gong HS (2010) Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med 38:672–678
Oh JH, Yoon JP, Kim JY, Kim SH (2012) Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 21:715–721
Ozbaydar MU, Tonbul M, Tekin AC, Yalaman O (2007) Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors. Acta Orthop Traumatol Turc 41:169–174
Pai VS, Lawson DA (2001) Rotator cuff repair in a district hospital setting: outcomes and analysis of prognostic factors. J Shoulder Elbow Surg 10:236–241
Park J-Y, Lhee S-H, Oh K-S, Moon SG, Hwang J-T (2013) Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear. Arthroscopy 29:280–289
Park J-Y, Siti HT, Keum J-S, Moon S-G, Oh K-S (2010) Does an arthroscopic suture bridge technique maintain repair integrity? A serial evaluation by ultrasonography. Clin Orthop Relat Res 468:1578–1587
Pauly S, Gerhardt C, Chen J, Scheibel M (2010) Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome? Knee Surg Sports Traumatol Arthrosc 18:1718–1729
Prasad N, Odumala A, Elias F, Jenkins T (2005) Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthop Belg 71:662–666
Robinson PM, Wilson J, Dalal S, Parker RA, Norburn P, Roy BR (2013) Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear. Bone Joint J 95-B:199–205
Romeo AA, Hang DW, Bach BR, Shott S (1999) Repair of full thickness rotator cuff tears. Gender, age, and other factors affecting outcome. Clin Orthop Relat Res 367:243–255
Russell RD, Knight JR, Mulligan E, Khazzam MS (2014) Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am 96:265–271
Sheibani-Rad S, Giveans MR, Arnoczky SP, Bedi A (2013) Arthroscopic single-row versus double-row rotator cuff repair: a meta-analysis of the randomized clinical trials. Arthroscopy 29:343–348
Sherman SL, Lyman S, Koulouvaris P, Willis A, Marx RG (2008) Risk factors for readmission and revision surgery following rotator cuff repair. Clin Orthop Relat Res 466:608–613
Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A (2007) Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 16:752–758
Tashjian RZ, Henn RF, Kang L, Green A (2006) Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am 88:536–540
Tashjian RZ, Hollins AM, Kim H-M, Teefey SA, Middleton WD, Steger-May K, Galatz LM, Yamaguchi K (2010) Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 38:2435–2442
Tashjian RZ, Hung M, Burks RT, Greis PE (2013) Influence of preoperative musculotendinous junction position on rotator cuff healing using single-row technique. Arthroscopy 29:1748–1754
Vad VB, Warren RF, Altchek DW, O’Brien SJ, Rose HA, Wickiewicz TL (2002) Negative prognostic factors in managing massive rotator cuff tears. Clin J Sport Med 12:151–157
Van Linthoudt D, Deforge J, Malterre L, Huber H (2003) Rotator cuff repair. Long-term results. Joint Bone Spine 70:271–275
Voigt C, Bosse C, Vosshenrich R, Schulz AP, Lill H (2010) Arthroscopic supraspinatus tendon repair with suture-bridging technique: functional outcome and magnetic resonance imaging. Am J Sports Med 38:983–991
Warrender WJ, Brown OL, Abboud JA (2011) Outcomes of arthroscopic rotator cuff repairs in obese patients. J Shoulder Elbow Surg 20:961–967
Worland RL, Arredondo J, Angles F, Lopez-Jimenez F (1999) Repair of massive rotator cuff tears in patients older than 70 years. J Shoulder Elbow Surg 8:26–30
Wu XL, Briggs L, Murrell GAC (2012) Intraoperative determinants of rotator cuff repair integrity: an analysis of 500 consecutive repairs. Am J Sports Med 40:2771–2776
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Saccomanno, M.F., Sircana, G., Cazzato, G. et al. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 3809–3819 (2016). https://doi.org/10.1007/s00167-015-3700-y
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DOI: https://doi.org/10.1007/s00167-015-3700-y