Arthroscopic rotator cuff repair: a systematic review of overlapping meta-analyses

Key points

1. 01Double-row repair significantly reduced retear rates in 4 of 7 meta-analyses and improved tendon healing in 3 of 5 meta-analyses, but did not produce clinically important functional improvements.
2. 02Platelet-rich plasma reduced retears specifically in small-to-medium tears (1-3 cm) across all 4 studies that examined this subgroup (p < 0.05), but only the pure PRP preparation showed benefit, not platelet-rich fibrin matrix.
3. 03Early-motion rehabilitation improved range of motion at 3, 6, and 12 months in the majority of meta-analyses without increasing retear risk in any of 6 studies.
4. 04Functional outcome scores (UCLA, ASES, Constant) were not meaningfully improved by any of the three interventions studied, suggesting structural gains do not always translate to patient-reported benefit.
5. 05The highest-quality, highest-evidence-level studies in each category consistently supported double-row repair, adjunctive pure PRP, and early motion.

How it was conducted

Design

Systematic review of overlapping meta-analyses (PRISMA guidelines)

Databases

MEDLINE, Embase, and Cochrane Library, searched February 2017

Included meta-analyses

24 meta-analyses: 10 on double-row vs. single-row repair, 7 on platelet-rich plasma vs. control, 7 on early vs. late motion

Total overlapping patients

11,518 across all included meta-analyses

Quality assessment

AMSTAR scale (0-11); mean scores were 9.0 for double-row, 9.3 for PRP, and 8.9 for rehabilitation meta-analyses

Primary outcomes

Retear rate, tendon-healing rate, functional scores (UCLA, ASES, Constant), and range of motion

What they found

• Double-row repair retear rates ranged from 13%-27% vs. 17%-43% for single-row repair across reporting meta-analyses; 4 of 7 studies showed significantly lower retear with double-row repair (p < 0.05), including both Level-I studies.
• Tendon-healing rates for double-row repair ranged 65%-78% vs. 46%-83% for single-row; 3 of 5 meta-analyses showed significantly higher healing with double-row (p < 0.05).
• UCLA shoulder score was significantly higher with double-row in 5 of 10 meta-analyses; ASES score was significantly higher in 2 of 10 meta-analyses (p < 0.05), but none reached clinical importance.
• Overall PRP retear rates ranged 15%-29% with PRP vs. 25%-38% without; only 2 of 7 meta-analyses showed a significant overall benefit (p < 0.05).
• For small-to-medium tears (1-3 cm), all 4 meta-analyses that analyzed this subgroup showed significantly lower retear with PRP (p < 0.05).
• Pure PRP (but not platelet-rich fibrin matrix) significantly reduced retear rate across all tear sizes and improved UCLA and Constant scores in 1 stratified study (p < 0.05).
• Early-motion retear rates ranged 14%-23% vs. 10%-20% for late motion; no single study showed a significant difference in retear rates (6 of 6 studies, p > 0.05).
• Range of motion was significantly better with early motion in 2 of 3 studies at 3 months, 4 of 5 studies at 6 months, and 3 of 5 studies at 12 months (p < 0.05).
• Only 1 of 3 meta-analyses showed a significant ASES score improvement with early motion (p < 0.05), and this did not reach clinical importance.

Limitations

• Overlapping meta-analyses included the same underlying randomized controlled trials, allowing only qualitative synthesis rather than pooled quantitative analysis.
• Heterogeneity in PRP preparation methods (volume, composition, leukocyte content) across included studies limits conclusions about optimal preparation.
• Tear size subgroup analyses were inconsistently reported, making it difficult to generalize findings across all tear sizes.
• Search was limited to English-language articles in three databases, and all limitations of the included meta-analyses carry forward into this review.

Why it matters

For patients

Patients undergoing rotator cuff repair may benefit from double-row technique for better healing and early physiotherapy to regain shoulder movement faster, with no added risk of re-tearing.

For clinicians

Double-row repair is preferred for structural outcomes; pure PRP (not fibrin matrix) can be considered as an adjunct especially in small-to-medium tears; early-motion rehabilitation protocols appear safe and effective for restoring range of motion.

For readers

This umbrella review synthesizes 24 meta-analyses to provide a clearer consensus on three debated aspects of arthroscopic rotator cuff repair, useful for guideline development and clinical decision-making.