Rates of retear following rotator cuff repair are similar between men and women

Hypothesis

A systematic review and meta-analysis was conducted investigating sex-based differences in retear rate after arthroscopic rotator cuff repair (RCR). It is hypothesized that females experience a higher rate of retear than males.

Methods

We performed a systematic review of 3 databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were written in English, published in a peer-reviewed journal, included patients with a history of arthroscopic RCR, reported failure rate based on sex, and had level of evidence 3 or higher. To assess failure, we used retear as our primary outcome, defined as a loss of structural integrity of the rotator cuff after primary repair, confirmed by imaging. Complications, reoperation, and patient-reported outcomes (PRO) were secondary outcomes.

Results

In 11 eligible studies, there were 3134 patients, 1787 female (57%) and 1476 male (43%). Of 11 studies, 10 reported sex-specific rates of retear, 3 reported complications by sex, 3 reported reoperation by sex, and 2 reported PROs by sex. A random-effects model demonstrated no significant difference in retear rates between females and males (mean difference, .010 [95% CI, −.068 to .087]; P = .81). Limited reporting prevented analysis for complication or reoperation rates. One study found significantly higher American Shoulder and Elbow Surgeons scores (92.2 vs. 88.2, P = .002), Constant-Murley Score scores (92.2 vs. 81.8, P < .001) and significantly lower visual analog scale pain scores (.75 vs. 1.39, P < .001) for males compared with females. No other significant differences in PROs were found. A random-effects model showed a significant difference in age between patients with and without retear (mean difference, 4.38 years [95% CI, 1.81-6.95]; P < .001).

Conclusion

Female and male patients showed no significant difference in retear rate following arthroscopic RCR. Retears were associated with increased age, which aligns with previous findings in the existing literature. Since many studies reported only one or a few of the desired outcomes, increasing the uniformity of outcome reporting related to RCR failure may be beneficial.