Prognostic Factors for Repair Integrity After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Background: Repair integrity is the most frequently assessed objective outcome after arthroscopic rotator cuff repair (ARCR). Multiple studies evaluated independent prognostic factors for repair integrity. However, there is a lack of a comprehensive quantitative review summarizing these findings. Purpose: To provide a descriptive synthesis of the published association estimates between candidate prognostic factors and repair integrity after ARCR. Study Design: Systematic review; Level of evidence, 4. Methods: The EMBASE, Medline, and Scopus databases were screened (January 2014-March 2024) for longitudinal studies with multivariate analyses and at least 6 months of follow-up (registration number: CRD42020199257). Association measures were converted to correlation coefficients ( r ) and pooled using a random-effects meta-analysis of prognostic factors and repair integrity, with definitions from individual studies. Data extraction, evaluation of the risk of bias in the included studies, and the certainty of the synthesized evidence were assessed by pairs of study authors using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies for Prognostic Factors (CHARMS-PF), Quality in Prognosis Study (QUIPS), and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tools, respectively. Results: Of 10,568 records, 30 studies met the inclusion criteria, representing 13,161 patients (mean age, 59 years; female participants: 45%). Recurrent defect rates ranged from 5% to 43%. The meta-analysis included 45% (92/206) of reported association measures, covering 15 factors across 27 studies. There was high-quality evidence supporting that increased age ( r = 0.02 [95% CI, 0-0.04]) was associated with higher recurrent defect rates. There was moderate quality evidence supporting that larger tear size ( r = 0.35 [95% CI, 0.21-0.45]), reduced acromiohumeral distance ( r = 0.32 [95% CI, 0.12-0.50]), greater degree of fatty infiltration of the supraspinatus ( r = 0.63 [95% CI, 0.14- 0.81]), and greater tear retraction ( r = 0.30 [95% CI, 0.15-0.42]) were associated with higher rates of recurrent defects. However, there was substantial heterogeneity across studies. The quality of evidence was deemed low to very low for most of the studied factors. Most included studies had a high risk of bias related to confounding, analysis, and reporting. Conclusion: Moderate- to high-certainty evidence supports 5 prognostic factors—including sociodemographic and diagnostic-related variables—as being associated with higher recurrent defect rates. These results may be used to prioritize further prognostic research studies.