Systematic Review
Does the Literature Confirm Superior Clinical Results in Radiographically Healed Rotator Cuffs After Rotator Cuff Repair?

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Purpose

Because recurrent or persistent defects in the rotator cuff after repair are common, we sought to clarify the correlation between structural integrity of the rotator cuff and clinical outcomes through a systematic review of relevant studies.

Methods

Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials were searched for all literature published from January 1966 to December 2008 that used the key words shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, integrity, healed, magnetic resonance imaging (MRI), computed tomography arthrography (CTA), and ultrasound. The inclusion criteria were studies (Levels I to IV) that reported outcomes after arthroscopic rotator cuff repair in healed and nonhealed repairs based on ultrasound, CTA, and/or MRI. Exclusionary criteria were studies that included open repair or subscapularis repair and studies that did not define outcomes based on healed versus nonhealed but rather used another variable (i.e., repair technique). Data were abstracted from the studies including patient demographics, tear characteristics, surgical procedure, rehabilitation, strength, range of motion, clinical scoring systems, and imaging studies.

Results

Thirteen studies were included in the final analysis: 5 used ultrasound, 4 used MRI, 2 used CTA, and 2 used combined CTA/MRI for diagnosis of a recurrent tear. Statistical improvement in patients who had an intact cuff at follow-up was seen in Constant scores in 6 of 9 studies; in University of California, Los Angeles scores in 1 of 2 studies; in American Shoulder and Elbow Surgeons scores in 0 of 3 studies; and in Simple Shoulder Test scores in 0 of 2 studies. Increased range of motion in forward elevation was seen in 2 of 5 studies and increased strength in forward elevation in 5 of 8 studies.

Conclusions

The results suggest that some important differences in clinical outcomes likely exist between patients with healed and nonhealed rotator cuff repairs. Further study is needed to conclusively define this difference and identify other important prognostic factors related to clinical outcomes.

Level of Evidence

Level IV, systematic review.

Section snippets

Literature Search

We searched Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials for all literature published from January 1966 to December 2008 using the following key words: shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, integrity, healed, magnetic resonance imaging (MRI), computed tomography arthrography (CTA), and ultrasound. General search terms were chosen to prevent the possibility of missing

Literature Search

There were 640,597 articles found with all of the general search terms; these were limited to the English language and human subjects, leaving 441,432 articles. Each of the search terms was then combined with one other term by use of PubMed advanced search to locate those pertinent to the study. The abstracts of each of the combined searches were then reviewed to determine appropriateness for inclusion in the study. There were 35 articles that were deemed appropriate for the analysis. Of the 35

Discussion

As surgical techniques for arthroscopic rotator cuff repair become more advanced and less invasive, hopefully, patient satisfaction after surgery will continue to improve. Of concern is that despite high patient satisfaction rates, healing rates after arthroscopic rotator cuff repair as low as 6% have been reported.30 However, the relation between structural healing of the rotator cuff and clinical outcomes remains poorly defined. Our study qualitatively describes the clinical results of

Conclusions

This systematic review suggests that some important differences in clinical outcomes likely exist between patients with healed and nonhealed rotator cuff repairs; however, the results of this systematic review cannot definitely state that the results for healed rotator cuff repairs are better based on any of the clinical outcomes because of the mixed results in the studies included. With regard to the primary clinical outcome measures used in each study, 7 of 13 studies found a statistical

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    The authors report no conflict of interest.

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