This systematic review pooled 29 studies (1,583 patients) with a minimum 5-year follow-up. It asks whether rotator cuff repair actually alters the natural history of cuff disease compared with no repair. Meta-regression adjusted for age, sex, tear size, and follow-up duration.
When counseling a patient with a full-thickness cuff tear, this review sharpens the message: repair reliably shrinks the final tear and cuts the odds of needing another operation. But it does not clearly buy better pain, strength, motion, or Constant scores at 5 to 15 years versus no repair.
The conceptual pearl is that a recurrent defect after repair occurs at the same rate as tear progression without surgery. The authors frame a re-tear as continued biological degeneration, not a technical failure. There is a decision-making corollary: because tear size, age, and atrophy all worsen with nonoperative delay, waiting reduces the chance of achieving an intact tendon if you later repair.
Weight this as Level IV evidence. Pooled heterogeneous cohorts and residual baseline differences mean only a randomized trial can settle whether repair truly alters natural history.
This systematic review pooled 29 studies (1,583 patients) with a minimum 5-year follow-up. It asks whether rotator cuff repair actually alters the natural history of cuff disease compared with no repair. Meta-regression adjusted for age, sex, tear size, and follow-up duration.
When counseling a patient with a full-thickness cuff tear, this review sharpens the message: repair reliably shrinks the final tear and cuts the odds of needing another operation. But it does not clearly buy better pain, strength, motion, or Constant scores at 5 to 15 years versus no repair.
The conceptual pearl is that a recurrent defect after repair occurs at the same rate as tear progression without surgery. The authors frame a re-tear as continued biological degeneration, not a technical failure. There is a decision-making corollary: because tear size, age, and atrophy all worsen with nonoperative delay, waiting reduces the chance of achieving an intact tendon if you later repair.
Weight this as Level IV evidence. Pooled heterogeneous cohorts and residual baseline differences mean only a randomized trial can settle whether repair truly alters natural history.