Return to Sports After Surgical Treatment of Rotator Cuff Tear in Young Athletes: A Systematic Review and Meta-analysis

Background: Young athletes who undergo surgery for a rotator cuff tear (RCT) are expected to return to sports (RTS) at the preinjury level.

Purpose: To determine the rate and level of RTS and associated factors after RCT surgery in young athletes.

Study design: Systematic review; Level of evidence, 4.

Methods: A literature search was performed in PubMed, Embase, and Cochrane Library the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were studies in English evaluating RTS after surgical treatment of RCTs in athletes <40 years. Study quality was evaluated according to the Methodological Index for Nonrandomized Studies scores. Fixed-effects and random-effects meta-analyses were conducted to investigate the overall RTS rate and the ability to RTS at the preinjury level and explore the heterogeneity of the studies.

Results: Of 168 studies initially identified, 13 studies (332 athletes; 270 competitive and 62 recreational) were included. The mean age of the athletes was 26.1 years (range, 13.2-39 years). Eleven studies (289 athletes) reported the type of sports; the most common sports were baseball (n = 195), football (n = 47), and tennis (n = 13). A total of 25 athletes were lost to follow-up, leaving 307 athletes with postoperative RTS data for meta-analysis. The combined rate of RTS according to the fixed-effects model was 84% (95% CI, 80%-88%). The level of RTS was evaluated in 11 studies (251 athletes), and according to the random-effects models, the combined rate of RTS at the preinjury level was 63% (95% CI, 49%-77%). In a subgroup analysis, the rate of RTS at the preinjury level was significantly different between competitive athletes (61% [95% CI, 46%-76%]) and recreational athletes (89% [95% CI, 78%-99%]) (P = .004).

Conclusion: Results of this review indicated that most young athletes were able to RTS after RCT surgery, and more than half were able to RTS at the preinjury level. Compared with competitive athletes, a higher proportion of recreational athletes were able to RTS at the preinjury level after surgery.