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

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.