The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis

Abstract

Hypothesis The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair. Methods We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year. Results The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies ( Q = 209.53, I 2 = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate ( P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195). Conclusion The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.

Clinical and Radiologic Outcomes after Anatomical Total Shoulder Replacement Using a Modular Metal-Backed Glenoid after a Mean Follow-Up of 5.7 Years

“…Our age distribution correlates with similar results of specific studies published by Gauci et al [ 16 ] and Taunton et al [ 21 ]. Age could also play a considerable part in the results since older patients may have a lower functional demand than younger patients or tend to have higher rates of RTC deficiency, which correlates with patient age [ 22 ]. It has been argued that, in comparison to older patients, young patients have higher functional demands and higher expectations of enhanced capacity for social interaction, participation in sports, and exercise [ 23 ].…”

A bio-inductive collagen scaffold that supports human primary tendon-derived cell growth for rotator cuff repair

“…There are a number of risk factors reported in meta-analyses of outcomes of rotator cuff surgery that can contribute to a higher rate of re-tearing. These include age [ 55 ], size of the initial tear [ 56 ], level of post-surgical activity [ 57 ], prior corticosteroid administration [ 58 ], low HDL levels [ 59 ] as well as co-existent shoulder pathology or a fibro-inflammatory genotype of the repaired tendon [ 60 ] and further studies will be required to determine the causes of re-tearing following augmentation of RC repairs with BCS.…”

Re-tears after rotator cuff repair: Current concepts review

“…Increasing age has been associated with increased rates of retear following rotator cuff repair. 4,7 Diebold et al described a large single surgeon series of 1600 patients and identified a re-tear rate of 5% in patients under the age of 50 years, 10% re-tear rate in patients aged 50e59 years, 15% in patients aged 60e69 years and 25% in patients aged 70e79 years and increasing to 34% in patients over the age of 80 years. 4 Systemic factors such as low bone mineral density (BMD), hyperlipidaemia (HL) and poor glycaemic control in diabetic patients have also been shown to be significant risk factors associated with failure of rotator cuff repair.…”