Return to Sport After Arthroscopic Rotator Cuff Repair: Is There a Difference Between the Recreational and the Competitive Athlete?

Abstract

Background: Return to sport (RTS) remains an important challenge and measure of success for athletes undergoing arthroscopic rotator cuff repair (RCR). Purpose: To determine the rate of RTS after RCR and to analyze predictive factors associated with a lower rate of return. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. Study quality was evaluated according to the Coleman Methodology Score. Studies in English evaluating RTS after arthroscopic repair of partial- or full-thickness rotator cuff tears among athletes of all levels, ages, and sports were included. Random effects meta-analysis and metaregression were performed to investigate RTS activity rate after arthroscopic RCR and to explore study heterogeneity, respectively. Results: Fifteen studies were reviewed, including 486 patients (499 shoulders) who were treated with arthroscopic RCR and who had a mean follow-up of 40.1 months (range, 18-74.4 months). Eighteen patients were lost to follow-up, leaving 468 patients with outcome data; 347 identified themselves as athletes (81 competitive, 266 recreational). The most commonly included sports were baseball (n = 45), golf (n = 38), football (n = 23), and tennis (n = 18). RTS specific to the type of athlete was reported for 299 of 347 athletes. According to the meta-analysis, the overall rate of RTS at a similar level of play or higher was 70.2%, with 73.3% of recreational athletes and 61.5% of competitive athletes able to return. A subset of 43 baseball and softball players across 4 studies yielded a 79% rate of RTS; however, only 38% returned to the same level of play or higher. Subgroup meta-analysis revealed no significant difference in the rate of RTS between competitive and recreational athletes. Metaregression analysis revealed that the mean follow-up time and mean age at surgery were not significantly associated with RTS rate. Conclusion: Most athletes (70.2%) were able to return to a preinjury level of play after arthroscopic RCR. While recreational sports participation (73.3%) was associated with higher return, competitive sports (61.5%) and overhead sports (38%) were associated with lower return. Exactly why all athletes do not return remains uncertain and likely multifactorial.

Excellent Clinical Outcomes and Rates of Return to Play After Arthroscopic Rotator Cuff Repair for Traumatic Tears in Athletes Aged 30 Years or Less

“…Recent studies by both Altintas et al. 39 and Millett et al. 9 found that despite nearly three-quarters of athletes successfully being able to RTP after their ARCR procedure, approximately 60% of competitive athletes managed to do so at their desired level.…”

Electromyography activity of the teres minor muscle with varying positions of horizontal abduction in the quadruped position

“… 5 Thirty-eight percent of the throwing athletes were only able to return to the same level of play or higher after rotator cuff repairs although 79% of the athletes were able to return to play. 1 The occupational ratio of the TMi muscle can be increased as compensational hypertrophy in shoulders with tears in the supraspinatus and IS muscles. 17 In addition, relatively high activity of the TMi muscle was observed during acceleration, deceleration, and follow-through phases of throwing, compared with the activity of IS muscle.…”

Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

“…26,35,45 The available literature has mainly demonstrated that most patients successfully return to their preoperative activity level after surgery. [3][4][5]23,24,48 Kim et al 22 performed radiographic assessments to observe how structural integrity influences the time of return to activity. Mihata et al 31 reported the state of tendon healing in active patients but specifically focused on patients who underwent superior capsule reconstruction.…”

“…Nonetheless, the published literature concerning active patients has focused on returning to preoperative activities, [3][4][5]24,27,48 and very few radiographic or detailed functional data concentrating on the effect of postoperative activities have been reported. 2,31 Owing to this lack of information, outcome-based guidelines for active patients, in terms of postoperative activity level management, are unavailable.…”