Affiliation:
1. Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
2. Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
3. Department of Orthopaedic Surgery, Bergman Clinics, Naarden, the Netherlands
Abstract
Background: Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear. Purpose: To assess the role of delay to surgery on the outcomes of RCR in the literature. Study Design: Systematic review with meta-analysis; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR—either retear rates or patient-reported outcome measures (PROMs)—and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age <65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of PROMs. Random-effect models were used to assess outcomes, reported in odds ratio (OR) or mean difference (MD) with 95% CIs. Results: A total of 8118 patients were included from 33 studies, with a mean age of 59 years (range, 53-64) and mean follow-up of 3.0 years (range, 0.5-8.2), among whom 53% were male and 74% had dominant-side injury. Patients undergoing surgery >3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, −6.2 [95% CI, −16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, –12.9 [95% CI, −26.0 to −0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with <1 year (OR, 2.9 [95% CI, 2.1 to 4.0]; P < .001), and this was similar for the 2-year cutoff (OR, 5.9 [95% CI, 1.1 to 32.1]; P = .040). It was also noted that patients with an intact cuff at follow-up had a mean 3.9 months’ shorter time from injury to surgery than patients with retear (95% CI, 1.0-6.8 months; P = .009). Conclusion: This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior PROMs as compared with undergoing earlier surgery. However, delaying surgery for ≥1 year clearly resulted in higher retear rates after RCR. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings. Registration: CRD42021240720 (PROSPERO).
Subject
Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine