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
- 1Department of Orthopaedics, Beijing Hospital, National Center for Gerontology; National Clinical Research Center for Gerontology; The Key Laboratory of Geriatrics of NHC; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, DongDan, Beijing, 100730 People’s Republic of China
- 2Peking University Fifth School of Clinical Medicine, NO.1 Da Hua Road, DongDan, Beijing, 100730 People’s Republic of China
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 I2, 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12891-026-10337-7.
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BibTeX
@article{wang2026incidence,
title = {{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}},
author = {Hongyu Wang and Zhiruo Jiang and Qingyun Xue and Lei Shi and Fei Wang and Haishi Zheng and Lin Wang},
journal = {BMC Musculoskeletal Disorders},
year = {2026},
month = aug,
doi = {10.1186/s12891-026-10337-7},
url = {https://doi.org/10.1186/s12891-026-10337-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Hongyu Wang
AU - Zhiruo Jiang
AU - Qingyun Xue
AU - Lei Shi
AU - Fei Wang
AU - Haishi Zheng
AU - Lin Wang
PY - 2026
DA - 2026/08/10
JO - BMC Musculoskeletal Disorders
DO - 10.1186/s12891-026-10337-7
UR - https://doi.org/10.1186/s12891-026-10337-7
AB - 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 I2, 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12891-026-10337-7.
SN - 1471-2474
ER -