This PRISMA-compliant systematic review and meta-analysis of 31 level 1–2 studies asks two questions: when do rotator cuff retears occur after surgical repair, and which factors drive healing failure? Retear rates were quantified across five follow-up windows, and odds ratios were calculated for age, tear size, fatty infiltration, rehabilitation timing, repair construct, PRP, and tendon augmentation.
Counsel every rotator cuff repair patient that roughly 1 in 5 repairs will show a retear on imaging regardless of when you image them. That number climbs to 1 in 4 for patients over 60, and approaches 1 in 3 for large or massive tears — preoperative discussion should be specific, not generic.
When structuring postoperative rehab, the data support a defined window: hold active-assisted ROM until at least 5 weeks, but advance to full active ROM by 8 weeks. Deviating in either direction independently raises retear risk on imaging.
For construct selection, double-row repair outperforms suture bridge/transosseous on retear rate, but not single-row repair. The clinical decision should weigh tear geometry and tissue quality, not a reflexive preference for complexity.
Fatty infiltration, widely taught as a key predictor, did not reach significance here, likely due to sparse data. Do not abandon it as a counseling point, but recognize the evidence base is thinner than commonly assumed.
This PRISMA-compliant systematic review and meta-analysis of 31 level 1–2 studies asks two questions: when do rotator cuff retears occur after surgical repair, and which factors drive healing failure? Retear rates were quantified across five follow-up windows, and odds ratios were calculated for age, tear size, fatty infiltration, rehabilitation timing, repair construct, PRP, and tendon augmentation.
Counsel every rotator cuff repair patient that roughly 1 in 5 repairs will show a retear on imaging regardless of when you image them. That number climbs to 1 in 4 for patients over 60, and approaches 1 in 3 for large or massive tears — preoperative discussion should be specific, not generic.
When structuring postoperative rehab, the data support a defined window: hold active-assisted ROM until at least 5 weeks, but advance to full active ROM by 8 weeks. Deviating in either direction independently raises retear risk on imaging.
For construct selection, double-row repair outperforms suture bridge/transosseous on retear rate, but not single-row repair. The clinical decision should weigh tear geometry and tissue quality, not a reflexive preference for complexity.
Fatty infiltration, widely taught as a key predictor, did not reach significance here, likely due to sparse data. Do not abandon it as a counseling point, but recognize the evidence base is thinner than commonly assumed.