Abstract
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The relationship between functional disability and health-related quality of life in patients with a rotator cuff tear.Disabil Rehabil. 2012; 34: 2071-2075
- Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon: evaluation of the clinical and functional outcomes after two years of follow-up.Rev Bras Ortop. 2015; 47: 436-440
- The incidence of full thickness rotator cuff tears in a large cadaveric population.Bulletin. 1995; 54: 30-31
- Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area.Arthroscopy. 2002; 18: 519-526
- Massive rotator cuff tears: the result of partial rotator cuff repair.J Shoulder Elbow Surg. 2005; 14: 121-127
- Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up.Arthroscopy. 2002; 18: 136-144
- Acute tears of the rotator cuff. The timing of surgical repair.Clin Orthop Relat Res. 1983; 175: 18-24
- Open, mini-open, and all-arthroscopic rotator cuff repair surgery: indications and implications for rehabilitation.J Orthop Sports Phys Ther. 2009; 39: 81-89
- Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study.J Shoulder Elbow Surg. 2006; 15: 290-299
- Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff.Arthroscopy. 1994; 10: 54-60
- Repairs of the rotator cuff: correlation of functional results with integrity of the cuff.J Bone Joint Surg Am. 1991; 73: 982-989
- Factors predicting rotator cuff tears: an analysis of 1000 consecutive rotator cuff repairs.Am J Sports Med. 2014; 42: 1134-1142
- Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function.Am J Sports Med. 2013; 41: 1674-1683
- Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair.J Bone Joint Surg Am. 2012; 94: e48
- Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors.Am J Sports Med. 2011; 39: 2099-2107
- Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II–prognostic factors for clinical and radiographic outcomes.J Shoulder Elbow Surg. 2011; 20: 941-946
- Modified impingement test can predict the level of pain reduction after rotator cuff repair.Am J Sports Med. 2010; 38: 1383-1388
- Factors affecting healing rates after arthroscopic double-row rotator cuff repair.Am J Sports Med. 2010; 38: 2435-2442
- The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder.Clin Orthop Surg. 2009; 1: 96-104
- Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome.J Shoulder Elbow Surg. 2009; 18: 13-20
- Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome.Arthroscopy. 2009; 25: 30-39
- 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. 2007; 35: 719-728
- Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors.Acta Orthop Traumatol Turc. 2007; 41: 169-174
- Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs.Am J Sports Med. 2004; 32: 1716-1722
- Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.J Shoulder Elbow Surg. 2003; 12: 550-554
- Arthroscopically assisted mini-open rotator cuff repair.Arthroscopy. 2002; 18: 21-26
- Rotator cuff repair in a district hospital setting: outcomes and analysis of prognostic factors.J Shoulder Elbow Surg. 2001; 10: 236-241
- Repair of the rotator cuff. A comparison of results in two populations of patients.J Bone Joint Surg Am. 1995; 77: 1335-1339
Cochrane prognosis methods group. Available at: http://prognosismethods.cochrane.org/more-about-us. Accessed April 08, 2016.
- Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review.J Orthop Sports Phys Ther. 2014; 44: 153-163
- Specific patient-related prognostic factors for rotator cuff repair: a systematic review.J Shoulder Elbow Surg. 2014; 23: 1073-1080
- Meta-analysis.in: Rothman K.J. Greenland S. Lash T. Modern Epidemiology. 3rd ed. Lippincott Williams and Wilkins, Philadelphia, PA2008: 652
- Risk factors for persistent problems following whiplash injury: results of a systematic review and meta-analysis.J Orthop Sports Phys Ther. 2009; 39: 334-350
- Critical appraisal of study quality for prognostic articles. Interpretation guide.(In Press)in: Law M. MacDermid J. Evidence-based Rehabilitation. 3rd ed. Slack Inc., Thorefare, NJ2013
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit.Psychol Bull. 1968; 70: 213-220
- Fixed- and random-effects models in meta-analysis.Psychol Meth. 1998; 3: 486-504
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- The file drawer problem and tolerance for null results.Psychol Bull. 1979; 86: 638-641
- Meta-analytic procedures for social research.Sage, Beverly Hills, CA1984
- The Handbook of Research Synthesis.1st ed. Russell Sage Foundation, New York, NY1994
Cochrane handbook for Systematic reviews of Interventions. Available at: http://handbook.cochrane.org/chapter_9/9_5_2_identifying_and_measuring_heterogeneity.htm. Accessed April 14, 2016.
- Scoring systems for the functional assessment of the shoulder.Arthroscopy. 2003; 19: 1109-1120
- Shoulder scoring scales for the evaluation of rotator cuff repair.Clin Orthop Relat Res. 2004; 427: 107-114
- Measuring shoulder function: a systematic review of four questionnaires.Arthritis Rheum. 2009; 61: 623-632
- Outcome analysis after open reconstruction of rotator cuff ruptures. A comparative assessment of recent evaluation procedures.Unfallchirurg. 2001; 104: 480-487
- Repair of the rotator cuff. End-result study of factors influencing reconstruction.J Bone Joint Surg Am. 1986; 68: 1136-1144
- Repair of full thickness rotator cuff tears. Gender, age and other factors affecting outcome.Clin Orthop Relat Res. 1999; : 243-255
- Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.J Bone Joint Surg Am. 1984; 66: 563-567
- Rotator cuff tear. Diagnosis and treatment.Clin Orthop Relat Res. 1983; 173: 78-91
- Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.Clin Orthop Relat Res. 1994; 304: 78-83
- Strategies for preventing prolonged disability in workers compensated for work related musculoskeletal disorders.Irsst, Montréal, Qué2012; 2011
- Does obesity affect early outcome of rotator cuff repair?.J Shoulder Elbow Surg. 2010; 19: 1250-1255
- Meta-analysis in medical research.Hippokratia. 2010; 14: 29-37
- Clinically useful measures of effect in binary analyses of randomized trials.J Clin Epidemiol. 1994; 47: 881-889
- When can odds ratios mislead?.BMJ. 1998; 316: 989-991
- Publication bias in meta-analysis: its causes and consequences.J Clin Epidemiol. 2000; 53: 207-216
Consolidated Standards of Reporting Trials. CONSORT— transparent reporting of trials. Available at: www.consort-statement.org/. Updated January 20, 2012. Accessed February 12, 2013.
Strengthening the report of observational studies in epidemiology. STROBE Statement. Available at: http://www.strobe-statement.org/index.php?id=available-checklists. Version 4 as published in Oct/Nov 2007. Accessed July 3rd, 2013.
JHT Read for Credit
Quiz: #488
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Data was collected via
- a.patient interviews
- b.manual chart reviews
- c.electronic literature search
- d.library literature search
- a.
- #2.A very significant factor in predicting poor outcomes was
- a.fatty infiltration
- b.patient age
- c.lesion on dominate arm
- d.open vs. closed surgical technique
- a.
- #3.Which factors were not significant in predicting outcomes
- a.a history of trauma
- b.smoking
- c.duration of symptoms
- d.all of the above
- a.
- #4.The study methodology was based on
- a.only RCTs
- b.only qualitative reports
- c.pooled data
- d.ASHT guidelines
- a.
- #5.The authors suggest that we need more RCTs studies in the future
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: February 22, 2017
Accepted:
November 2,
2016
Received in revised form:
September 23,
2016
Received:
November 16,
2015
Footnotes
Conflict of interest: The authors have no conflict of interests to report.
The primary author was a PhD candidate at the time of the study. Apart from the funding related to PhD from the University, there was no external funding for this study from any external source.
Identification
Copyright
© 2016 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
