Predictors of outcomes after rotator cuff repair—A meta-analysis
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STUDY DESIGN: Systematic review. INTRODUCTION: Clinical outcomes associated with rotator cuff repair (RCR) are generally favorable, but no study has attempted to establish a set of predictors that affect outcomes. PURPOSE OF STUDY: This study aims to statistically analyze articles and establish a set of predictors that affect outcomes after RCR. METHODS: An electronic literature search of multiple databases was conducted to identify studies that addressed prognosis after RCR. Quality ratings were conducted with a prognostic study evaluation tool. Summary data for predictors and outcomes were extracted, entered in comprehensive meta-analysis software, transformed where necessary, and pooled to allow for estimation of odds ratio for each predictor. RESULTS: From 18 studies, 3 were high quality, 7 were moderate and 8 were low-quality studies. Fatty infiltration had a significant negative effect (OR = 9.3), whereas larger tear size, lower preoperative muscle strength (OR = 4.0), multiple tendon involvement (OR = 6.0), diabetes, and worker's compensation status (OR = 8.7) had a moderate negative effect on outcomes after RCR. Older age had a modest negative effect on cuff integrity at follow-up (OR = 2.8), but no significant effect on function. In addition, a history of trauma, smoking, and duration of symptoms before surgery had no significant effect on outcomes. DISCUSSION: Injury to the cuff (body structure), physical impairment, personal factors and social factors affects outcomes; although the importance of predictors varies between anatomic and functional outcomes. CONCLUSIONS: A multifactorial biopsychosocial prognosis should be considered in management. LEVEL OF EVIDENCE: Level 2.
