Factors affecting healing after arthroscopic rotator cuff repair

Table 1 Studies evaluating factors affecting healing after rotator cuff repair

Study	Study type	Number of patients/duration of follow up	Primary outcome	Conclusion	Level of evidence
Age
Boileau et al[5]	Case series	65 pts/29 mo	CT arthrogram, MRI	Healing rate significantly lower in patients > age 65	IV
Tashjian et al[11]	Case series	48 pts/16 mo	US	Older age associated with lower tendon healing rate	IV
Cho et al[12]	Case series	120 pts/25.2 mo	MRI	Older age associated with lower tendon healing rate	IV
Oh et al[13]	Case series	177 pts/29 mo	CT arthrogram	Older age was related to poor postoperative repair integrity	IV
Tear size
Galatz et al[6]	Case series	18 pts/36 mo	US	High rate of tendon healing failure	IV
Chung et al[15]	Case series	108 pts/31.7 mo	CT arthrogram, US	High rate of tendon healing failure	IV
Fatty infiltration/atrophy
Thomazeau et al[22]	Case series	30 pts/21.1 mo	MRI	Supraspinatus atrophy was a strong risk factor for retear	IV
Liem et al[10]	Case series	53 pts/26.4 mo	MRI	Higher degrees of muscular atrophy and fatty infiltration preoperatively are associated with tear recurrence	IV
Goutallier et al[23]	Case series	220 shoulders/37 mo	CT arthrogram, MRI	The likelihood of a recurrent tear was greater for tendons whose muscle showed fatty degeneration greater than grade 1	IV
Chung et al[15]	Case series	108 pts/31.7 mo	CT arthrogram, US	Higher FI of the infraspinatus was the single most important factor negatively affecting cuff healing	IV
Tendon retraction
Meyer et al[31]	Retrospective cohort	33 shoulder/24 mo	MRI	The combination of Goutallier grading and preoperative tendon length appears to be a more powerful predictor for the reparability of a tendon tear than Goutallier grading alone	III
Tashjian et al[32]	Case series	51 pts/25 mo	MRI	The position of the MTJ with respect to the glenoid face can be predictive of healing, with over 90% healing if lateral and 50% if medial to the face	IV
Other patient factors
Neyton et al[36]	Case series	105 pts/16.1 mo	MRI	Smoking was detrimental to healing	IV
Chung et al[14]	Retrospective cohort	408 pts/37.2 mo	CT arthrogram, US	Bone mineral density, as well as FI of the infraspinatus and amount of retraction, was an independent determining factor affecting postoperative rotator cuff healing	III
Abboud et al[38]	Case-control	147 pts/NA	NA	Patients with rotator cuff tears were more likely to have hypercholesterolemia when compared with the control group	II
Repair construct
Lapner et al[49]	RCT	90 pts/24 mo	MRI, US	Smaller initial tear size and a double-row fixation technique were associated with higher healing rates	I
Burks et al[52]	RCT	40 pts/12 mo	MRI	No clinical or MRI differences found between patients repaired with a SR or DR technique	I
Mihata et al[53]	RCT	201 pts/38.5 mo	MRI, US	Retear rate in the compression double-row group was significantly less than in the single-row group and the double-row group	I
Gartsman et al[54]	RCT	90 pts/10 mo	US	Arthroscopic double-row suture bridge repair resulted in a significantly higher tendon healing rate compared to single-row repair	I
Kim et al[55]	Case series	79 pts/30.6 mo	MRI, US	The re-tear rate after suture-bridge repair was 15%	IV
Rehabilitation
Lee et al[62]	RCT	64 shoulders/7.6 mo	MRI	More patients in the aggressive early passive rehabilitation group (23.3%) had retears compared to the limited early passive group (8.8%) although not statistically significant	II
Kim et al[61]	RCT	105 pts/12 mo	MRI, CT arthrography	Early passive motion did not negatively affect cuff healing	I
Biologics (PRP/MSCs)
Weber et al[75]	RCT	60 pts/12 mo	MRI	Healing rates did not differ between groups	I
Rodeo et al[76]	RCT	79 pts/12 wk	US	No differences in tendon-to-bone healing between the PRFM and control groups	II
Bergeson et al[77]	Prospective cohort	37 pts/27 mo in control group and 13 mo in PRFM group	MRI	No differences in retear rates between the PRFM and control groups	III
Barber et al[78]	Case-control	40 pts/31 mo	MRI	PRFM group had lower retear rates than control group	III
Jo et al[79]	RCT	48 pts/15.9 in PRP group and 17.3 in control group	MRI	Retear rate in the PRP group was significantly lower than in the control group	I
Hernigou et al[86]	Case-control	90 pts/10 yr	MRI	Higher rate of healing and reduced number of re-tears over time in the MSC groups compared to the control group	III

CT: Computed tomography; MRI: Magnetic resonance imaging; PRFM: Platelet rich fibrin matrix; MSC: Mesenchymal stem cell; PRP: Platelet-rich plasma; US: Ultrasound; MTJ: Muscle-tendon junction; DR: Double row; SR: Single row; FI: Fatty infiltration; NA: Not applicable; RCT: Randomized controlled trial.