A Systematic Review and Meta-analysis of Risk Factors for the Increased Incidence of Revision Surgery After Arthroscopic Rotator Cuff Repair.

BACKGROUND

Approximately 90% of patients who undergo arthroscopic rotator cuff repair (RCR) are satisfied with their pain levels and function after surgery. However, a subset of patients experience continued symptoms that warrant revision surgery. Preoperative risk factors for RCR failure requiring revision surgery have not been clearly defined.

PURPOSE

To (1) determine the rate of RCR failure requiring revision surgery and (2) identify risk factors for revision surgery, which will help surgeons to determine patients who are at the greatest risk for RCR failure.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 4.

METHODS

A systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were performed. The initial search resulted in 3158 titles, and 533 full-text articles were assessed for eligibility. A total of 10 studies met the following inclusion criteria: (1) human clinical studies, (2) arthroscopic RCR, (3) original clinical research, and (4) evaluation of preoperative risk factors for revision.

RESULTS

After a full-text review, a total of 16 risk factors were recorded and analyzed across 10 studies. Corticosteroid injection was the most consistent risk factor for revision surgery, reaching statistical significance in 4 of 4 studies, followed by workers' compensation status (2/3 studies). Patients with corticosteroid injections had a pooled increased risk of revision surgery by 47% (odds ratio, 1.44 [95% CI, 1.36-1.52]). Patients with workers' compensation had a pooled increased risk of revision surgery by 133% (odds ratio, 2.33 [95% CI, 2.09-2.60]). Age, smoking status, diabetes, and obesity were found to be risk factors in half of the analyzed studies.

CONCLUSION

Corticosteroid injections, regardless of the frequency of injections, and workers' compensation status were found to be significant risk factors across the literature based on qualitative analysis and pooled analysis. Surgeons should determine ideal candidates for arthroscopic RCR by accounting for corticosteroid injection history, regardless of the frequency, and insurance status of the patient.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: M.H. has received personal fees from DJO/Enovis, Moximed, and Vericel; support for education from Smith & Nephew and Medwest Associates; and hospitality payments from Medical Device Business Services. G.E.G. has received consulting fees from Encore Medical, DePuy Synthes, Medical Device Business Services, Wright Medical Technology, Bioventus, and AzurMeds; royalties from Stryker, Encore Medical, and Wright Medical Technology; personal fees from Additive Orthopaedics, Mitek, and Tornier; and grants from Arthrex and SouthTech; he holds stock in cultivate(MD), Genesys, PatientIQ, ROM3, and Stryker. N.V. has received consulting fees and royalties from Arthrex; grants from Breg, Ossur, Smith & Nephew, and Wright Medical Technology; royalties from Smith & Nephew and Vindico Medical Education; and personal fees from Stryker. A.Y. has received consulting fees from AlloSource, CONMED Linvatec, JRF Ortho, and Olympus; is an unpaid consultant for PatientIQ, Smith & Nephew, and Sparta Biomedical; has received research support from Vericel, Arthrex, and Organogenesis; and hospitality payments from Stryker; and holds stock or stock options in PatientIQ. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.