Return to Sport After Rotator Cuff Tear Repair A Systematic Review and Meta-Analysis
Klouche S, Lefevre N, Herman S, Gerometta A, Bohu Y. Am J Sports Med. 2015. doi: 10.1177/0363546515598995.
Take Home Message: If an athlete suffers a rotator cuff tear, whether it is a partial or full thickness tear, their chances of returning to their previous level of play after surgery is favorable at the recreational level but not at the professional level.
Rotator cuff tears are a prevalent injury in athletics. A common goal for an athlete is to return to their previous level of performance after undergoing rotator cuff repair surgery and rehabilitation. The purpose of this meta-analysis was to determine if athletes returning from rotator cuff surgery could compete at a similar level post-repair compared to preinjury. The rate of return to play was assessed in two sub groups: professional athletes versus recreational athletes, and full thickness tears versus partial tears. Researchers conducted a systemic review with a meta-analysis to display the results of included articles in a clear and simple format. The authors used search engines including PubMed, Scopus, EMBASE, and the Cochrane Library with the phrases “rotator cuff tear/repair,” “return to sport/to play,” and “return to sport/ to play and athletes” to identify articles that were relevant to clinical question. A total of 859 patients (672 male, 187 female; 286 professional athletes, 349 recreational athletes) from 25 separate research studies were included in the meta-analysis to assess return to a similar performance level. The most commonly reported sports included baseball, tennis, and golf. Of reported injuries, approximately 42% were partial thickness tears, and 58% were full thickness tears. Surgical repairs included arthroscopic debridement, arthroscopic repair, repair by minimally invasive approach, and open surgery. Overall, 84% of patients returned to sport and 66% of patients returned to a similar level of performance within 4-17 months post-surgery. Recreational athletes had a better chance of returning to play at a similar level after surgery (81%) than professional athletes (50%). There was no relevant difference between athletes returning to activity at a similar level with partial (60%) or full thickness tears (71%). Just under 8% of patients had a partial or total retear after initial repair.
The significance of this meta-analysis is that outcomes of rotator cuff repair surgery are overall largely successful. Athletes in general had slightly better than an 80% chance of returning to sport. Furthermore, less than 8% of patients experienced a retear. Clinically, these finding enforce that the current surgical repair techniques are effective in returning patients to a functional, recreational quality of life. However, only one half of professional athletes were able to return to their pre-injury levels. Hence, surgical repairs may be less effective as higher demands are placed on the repair. This leaves room for improvement regarding the surgical aspect, and has also led to the recognition of possible risk factors for poor outcome that can be further studied and addressed to improve upon the result. These factors include degeneration, work related injuries, full-thickness tears, labrum related tears, and late surgery. Sports medicine clinicians should educate athletes with a rotator cuff tear about their chances of return to play after a rotator cuff repair. Professional athletes should recognize that the surgery does not guarantee a successful return to their preinjury levels.
Questions for Discussion: Would age of an athlete be an indicator when predicting the return to play at a similar level for athletes? What factors would make a professional athlete less likely to fully recover from a rotator cuff tear compared to a recreational level athlete?
Written by: Kyle Lewis, Michelle Moreau
Reviewed by: Jeffrey Driban
Predictors of Pain and Function in Patients with Symptomatic, Atraumatic Full-thickness Rotator Cuff TearsClinical Pearls: Tears of the Subscapularis Tendon
Klouche, S., Lefevre, N., Herman, S., Gerometta, A., & Bohu, Y. (2015). Return to Sport After Rotator Cuff Tear Repair: A Systematic Review and Meta-Analysis The American Journal of Sports Medicine DOI: 10.1177/0363546515598995