The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis

HYPOTHESIS: The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair. METHODS: We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year. RESULTS: The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies (Q = 209.53, I(2) = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate (P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195). CONCLUSION: The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.