Review Article
Specific patient-related prognostic factors for rotator cuff repair: a systematic review

https://doi.org/10.1016/j.jse.2014.01.001Get rights and content

Background

Many studies that describe factors affecting outcome in primary rotator cuff repair (RCR) have been published, but so far there is no review that summarizes them. This systematic review was conducted to identify prognostic factors influencing functional (clinical) outcome and radiologically proven cuff integrity after RCR.

Methods

A literature search was conducted up to July 2013 for prospective studies that describe prognostic factors affecting outcome in primary RCR. Inclusion criteria were open or arthroscopic repair of a full-thickness supraspinatus or infraspinatus tear. Included outcome measures were shoulder function and cuff integrity. Studies describing revision surgery, muscle transpositions, and subscapular or partial-thickness tears and those with retrospectively collected data were excluded, as were studies without linear or multivariate regression. The literature search resulted in 662 hits, and 12 of those studies were included in this review.

Results

Moderate evidence was found for increasing age, larger tear size, and additional biceps or acromioclavicular procedures to have a negative influence on cuff integrity at follow-up as well as for Workers' Compensation Board status to have a negative influence on functional outcome after RCR. There is limited evidence that performance of an additional acromioclavicular procedure has a negative influence on functional outcome. There was insufficient evidence for other described prognostic factors.

Conclusion

Several patient-specific factors influencing functional and radiologic outcome after RCR have been identified. These factors can guide orthopedic surgeons in their decision-making process as to whether to operate on their patients.

Section snippets

Literature search

A search of the literature in PubMed (from 1948 onward), EMBASE (from 1947 onward), PEDro (from 1929 onward), and the Cochrane Central Register of Controlled Trials was conducted to identify relevant publications until July 2013, without language restrictions. The literature search strategy for PubMed is presented in Table I.

Study selection and quality assessment

The publications had to meet the following selection criteria:

  • Study design: prospective studies that describe prognostic factors affecting outcome in primary RCR. Studies

Age

Mean age of the patients ranged from 52 to 59.5 years (overall range, 32-80 years). The prognostic importance of age on functional outcome was assessed in 1 high-quality study and 6 medium-quality studies.1, 9, 10, 14, 15, 19, 28 None of the studies showed that age had a significant influence on functional outcome. We conclude that there is insufficient evidence that age has an influence on functional outcome.

Age was assessed in 3 medium-quality studies to determine its influence on cuff

Discussion

Many articles have described prognostic factors for RCR; yet there are conflicting results, and adequate statistical analysis (e.g., multivariate regression analysis) is not always performed. This systematic review was designed to identify patient-specific prognostic factors influencing functional and radiologic outcome after RCR and summarizes the evidence available up to now.

Possible side effects of RCR are increased pain, re-tear, and stiff shoulder; less common are infection, implant

Conclusions

Indications for repair of nontraumatic RCT as part of a degenerative entity are not always evident. So far, no systematic review has described patient-specific prognostic factors for RCR. Selection of appropriate patients for surgery should prevent unsatisfactory postoperative results, reducing adverse events and health care costs.

Considering the available evidence as summarized in this review, performance of RCR should be carefully considered in patients from older age groups as well as in

Acknowledgment

The authors wish to thank Truus van Ittersum for her help in developing search strategies for the electronic databases used.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

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