Impact of rotator cuff surgery on postoperative sporting activity.

Abstract

The aim of this study was to systematically review the literature for the impact of rotator cuff tear (RCT) surgery on postoperative sporting activity in professional and recreational athletes. To identify any published clinical study on return to sports data for athletes following rotator cuff surgery, a systematic search in literature was conducted. Inclusion criteria were partial and full-thickness rotator cuff tears and any open or arthroscopic RCT surgery in sports participating people. E-published and print journal articles with a Level of Evidence I, II, III and IV were acceptable. The review was based on using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines. Included studies were assessed for reporting quality by using the Coleman Methodology Score (CMS). Twelve studies including 314 athletes met the inclusion criteria. From the 12 identified studies there were 10 studies with Level IV evidence with an average CMS of 45.2 (poor rating) and 2 studies with Level III evidence with an average CMS of 47 (poor rating). The mean time for returning to sports participation following RCT surgery was 8.3 months (4.8-10.7 months), 79% of all athletes returned to sports participation, therefrom 60.5% were able to return to their pre-injury level of competition. Forty-eight percent of the professional overhead athletes had reached their pre-injury level after RCT surgery. 20.3% participated at a lower level. Amongst professional overhead athletes, 54.5% were treated using arthroscopic debridement and 32.5% were treated using an arthroscopic repair technique. RTS rate to prior level of competition for arthroscopic debridement was 53.7% and 47.5% for arthroscopic repair. For recreational athletes RCT repair was reported for 62%. RTS rate to prior level of competition was 69.4% in this group of athletes. 38% were treated with an arthroscopic RCT repair. RTS rate to same level was 76% in this group. In contact athletes arthroscopic repair resulted in RTS rate of 91% to prior level of competition. Approximately 50% of professional overhead athletes return to their prior level of competition after arthroscopic RCT surgery. Professional athletes underwent arthroscopic surgery more often compared to recreational athletes with a comparable RTS rate after either arthroscopic debridement or repair. Open repair of RCT is mainly used for recreational athletes and results in a RTS rate of 70% to same level of competition. Although there is a lack of high quality studies in recent literature regarding this topic this study shows that RCT surgery has a crucial impact on postoperative level of competition in professional and recreational athletes. The present study enables the sports physician to better understand and discuss the consequences of rotator cuff surgery with athletes in daily clinical practice.