Moderate evidence supports that higher BMI is correlated with higher re-tear rates after rotator cuff repair surgery; however, strong evidence supports that there is no correlation between higher BMI and worse patient-reported outcomes following rotator cuff repair.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Moderate Evidence MODERATE EVIDENCE
Rationale
One high quality study (Kim 2018) demonstrated that higher BMI was associated with higher re-tear rates after rotator cuff repair.

Four high quality studies demonstrated either no difference in patient reported outcomes for patients with high BMI (Namdari 2010, Potter 2015, Wylie 2018), or improved patient reported outcomes in patients with higher BMI (Chalmers 2018) after rotator cuff repair, in part related to a lower starting ASES scores and pain VAS in patients with higher BMI.

Risks and Harms of Implementing this Recommendation
Patients with higher BMI may be at higher risk for perioperative complications, yet the literature supports that these patients should be treated surgically if indicated, as they can expect improved patient reported outcomes.

Future Research
Patients with higher BMI generally start with lower scores on patient reported outcome measures.  Future research should investigate if this starting point changes with weight loss, and how this affects the improvement in patient reported outcomes after surgery.
  1. Potter, M. Q., Wylie, J. D., Granger, E. K., Greis, P. E., Burks, R. T., Tashjian, R. Z. One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress. Clinical Orthopaedics & Related Research 2015; 11: 3501-10
  2. Wylie, J. D., Baran, S., Granger, E. K., Tashjian, R. Z. A Comprehensive Evaluation of Factors Affecting Healing, Range of Motion, Strength, and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine 2018; 1:
  3. Chalmers, P. N., Granger, E., Nelson, R., Yoo, M., Tashjian, R. Z. Factors Affecting Cost, Outcomes, and Tendon Healing After Arthroscopic Rotator Cuff Repair. Arthroscopy - Journal of Arthroscopic and Related Surgery 2018; 5: 1393-1400
  4. Kim, Y. K., Jung, K. H., Kim, J. W., Kim, U. S., Hwang, D. H. Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. Journal of Shoulder and Elbow Surgery 2018; 6: 1012-1020
  5. Namdari, S., Baldwin, K., Glaser, D., Green, A. Does obesity affect early outcome of rotator cuff repair?. Journal of Shoulder & Elbow Surgery 2010; 8: 1250-5