Revision rotator cuff repair: a systematic review

Background: The incidence of revision rotator cuff repair (RCR) has increased along with the incidence of primary RCR over the past 2 decades. The purpose of this study was to perform a systematic review to analyze the clinical outcomes of revision RCR and chiefly to identify prognostic factors that may influence postoperative outcomes. Methods: The PubMed, MEDLINE (Ovid), Embase (Elsevier), and Cochrane Library (Wiley) databases were searched from database inception through November 2018 for studies assessing revision RCR. All studies were screened in duplicate for eligibility. Pooled analysis correlations between mean preoperative range-of-motion measures, American Shoulder and Elbow Surgeons (ASES) scores, and visual analog scale (VAS) pain scores and mean postoperative outcomes with revision RCR were examined via linear regression and reported with the strength of the Spearman correlation coefficient (r_s). Results: A total of 22 studies met the inclusion criteria, including 3 level III and 19 level IV studies. Mean preoperative forward flexion had the greatest correlation with the mean postoperative ASES score (r_s = 0.98). A strong positive correlation was also found between mean preoperative forward flexion and mean postoperative forward flexion (r_s = 0.83). The mean preoperative VAS pain score was strongly correlated with the mean postoperative VAS pain score (r_s = 0.88) and demonstrated a moderate negative association with the mean postoperative ASES score (r_s = –0.48). Finally, the mean preoperative ASES score was moderately correlated with the mean postoperative ASES score (r_s = 0.56). Conclusions: The results of this systematic review demonstrate favorable clinical outcomes following RCR revision performed both in an open manner and arthroscopically. Preoperative forward flexion was identified as a possible prognostic factor for improved outcomes.