Are there significant differences in the clinical outcomes following arthroscopic rotator cuff repair which are reported in retrospective compared with prospective studies?

Aims As the number of patients who require arthroscopic rotator cuff repair (ARCR) continues to increase, the number of studies in which the clinical outcomes after this procedure are reported also increases. However, most studies reporting the outcomes of ARCR are retrospective with biases which are consistent with low levels of evidence. The aims of this study were to determine whether the clinical outcomes which have been reported following ARCR differ between retrospective and prospective studies. The hypothesis was that prospective studies report higher re-tear rates due to more rigorous follow-up and imaging techniques. Methods A literature search was performed using PRISMA guidelines to identify studies in which the clinical outcomes after ARCR with a minimum of 24 months’ follow-up were reported. Two independent investigators systematically collected data using inclusion and exclusion criteria, and assessed the quality of the included studies using the Modified Coleman Methodology Score. Results A total of 315 studies including 60,505 ARCRs were included. There were 232 retrospective and 83 prospective studies, including 54,237 and 6,268 repairs, respectively, with overall re-tear and revision rates of 16.7% and 3.7%, respectively. A significantly higher re-tear rate was reported in the prospective studies compared with the retrospective studies (18.8% vs 16.1%; p < 0.001). There was no significant difference in the revision rates between the two groups (both 3.7%; p = 0.161). Conclusion Significantly higher re-tear rates have been reported after ARCR in prospective studies rather than in retrospective studies. This was probably due to improved imaging and follow-up protocols used in prospective studies. However, revision rates remain low in both designs of study, suggesting that re-tears are usually asymptomatic. Surgeons should consider these findings when counselling patients who are considering undergoing an ARCR. Cite this article: Bone Joint J 2025;107-B(10):989–994.