Incidence and risk factors for rotator cuff retear after arthroscopic rotator cuff repair in middle-aged and older patients: a systematic review and meta-analysis

Abstract

Abstract Background Rotator cuff retear remains a major challenge after arthroscopic rotator cuff repair (ARCR), particularly among middle-aged and older patients. This study aimed to investigate the incidence of retear and identify its associated risk factors in this patient population. Methods A single-arm proportion meta-analysis was conducted to pool the overall retear rate among studies reporting the number of retear events, total sample size, and enrollment of > 50 participants. Furthermore, meta-analyses were performed for retear-related risk factors reported in the included studies, from which odds ratios (ORs) could be extracted or calculated. The methodological quality of the included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ) Checklist. Heterogeneity was evaluated using I 2 , and fixed- or random-effects models were selected accordingly. Sensitivity analyses and Egger’s tests were used to assess robustness and publication bias. Results In total, 273 studies (147,042 patients) were included in this single-arm proportion meta-analysis. The pooled overall retear rate after ARCR in middle-aged and older patients was 17% (95% confidence interval, 16%-18%). For the risk factor meta-analyses, 35 cohort/case-control studies (12,031 patients) were included. Retear risk was significantly associated with male sex (OR = 1.41), smoking history (OR = 2.21), diabetes mellitus (OR = 2.07), hyperlipidemia (OR = 3.45), greater fatty infiltration (supraspinatus Goutallier grade: OR = 2.70; infraspinatus Goutallier grade: OR = 2.79; global fatty degeneration index: OR = 3.64), and larger tear size (anteroposterior dimension per 1-cm increase: OR = 1.48; mediolateral dimension per 1-cm increase: OR = 1.17; large to massive tear: OR = 2.11). Conclusions Retear after ARCR is common in middle-aged and older patients, with an overall incidence of 17%. Retear is closely associated with metabolic comorbidities (diabetes mellitus and hyperlipidemia), male sex, smoking status, tear size, and degree of rotator cuff muscle fatty infiltration. Comprehensive preoperative evaluation incorporating these risk factors may improve risk stratification, guide surgical decision-making, and support the use of adjunctive strategies in high-risk patients to reduce retear rates and optimize outcomes.