This meta-analysis pooled 14 observational studies (5,693 patients) to quantify risk factors for retear after arthroscopic rotator cuff repair. Forty-five candidate factors were analyzed across sociodemographic, preoperative clinical, anatomical, and intraoperative domains. The goal was to identify which factors independently predict failure and which are modifiable targets for preoperative optimization.
Prior to this synthesis, risk stratification for rotator cuff retear was largely driven by individual studies with conflicting conclusions — particularly around factors like diabetes, repair technique, and fatty infiltration. No quantitative pooling had been done across all four risk domains simultaneously.
When counseling a patient preoperatively, flag the convergence of modifiable risks: uncontrolled diabetes, elevated BMI, low bone density, and symptom duration over 24 months each independently predict failure and can be targeted before surgery.
On MRI review, infraspinatus Goutallier grade ≥2 is the single most powerful imaging predictor (OR 11.02). Subscapularis infiltration at any grade also signals higher risk. Supraspinatus infiltration alone does not.
The null finding on repair construct matters in practice: if a patient has low bone density, large tear dimensions, and infraspinatus infiltration, choosing double-row over single-row will not rescue the repair. The underlying biology is the driver of failure.
Risk Factors Affecting Rotator Cuff Retear after Arthroscopic Repair: a Meta-Analysis and Systematic Review
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This meta-analysis pooled 14 observational studies (5,693 patients) to quantify risk factors for retear after arthroscopic rotator cuff repair. Forty-five candidate factors were analyzed across sociodemographic, preoperative clinical, anatomical, and intraoperative domains. The goal was to identify which factors independently predict failure and which are modifiable targets for preoperative optimization.
Prior to this synthesis, risk stratification for rotator cuff retear was largely driven by individual studies with conflicting conclusions — particularly around factors like diabetes, repair technique, and fatty infiltration. No quantitative pooling had been done across all four risk domains simultaneously.
When counseling a patient preoperatively, flag the convergence of modifiable risks: uncontrolled diabetes, elevated BMI, low bone density, and symptom duration over 24 months each independently predict failure and can be targeted before surgery.
On MRI review, infraspinatus Goutallier grade ≥2 is the single most powerful imaging predictor (OR 11.02). Subscapularis infiltration at any grade also signals higher risk. Supraspinatus infiltration alone does not.
The null finding on repair construct matters in practice: if a patient has low bone density, large tear dimensions, and infraspinatus infiltration, choosing double-row over single-row will not rescue the repair. The underlying biology is the driver of failure.