肩袖损伤的恢复结果

… rotator cuff repair in order to identify all the prognostic factors significantly associated with the outcomes … The hypothesis of the study was that some predictors of outcome are significantly …

… of the repair at follow-up and to patient-reported outcomes. … to the postoperative integrity of rotator cuff repair, with particular … related to the patient-reported outcomes of rotator cuff repair. …

… outcomes associated with rotator cuff repair (RCR) are generally favorable, but no study has attempted to establish a set of predictors that affect outcomes… that affect outcomes after RCR. …

… To the best of these authors' knowledge, this study represents the largest series reported to date of the outcome of repair of full-thickness rotator cuff tears by a single surgeon. …

… for patients with documented rerupture after open repair of one or more rotator cuff tendons … the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to …

… Thus, although we feel our results support the belief that functional outcomes after open rotator cuff repair are related to postoperative cuff integrity, unlike Harryman et al and …

Purpose To analyze the relationship between functional outcomes and postoperative cuff integrity (anatomic outcome), and to reveal the factors affecting outcomes of rotator cuff repair. Methods Seventy‐eight patients who had undergone repair of full‐thickness rotator cuff tear received both computed tomographic arthrography (CTA) and functional evaluation a minimum of 1 year after surgery. The mean follow‐up period was 19.6 months (range, 12 to 39 months). Anatomic outcome was evaluated by CTA. Functional outcomes were evaluated by visual analogue scale (VAS) for pain and satisfaction with the operation, Constant score, simple shoulder test (SST), and American Shoulder and Elbow Surgeons (ASES) score. Various clinical and structural factors were included for statistical analysis. Results All patients displayed significant improvement in all functional evaluations at the final visit. Functional outcome did not correlate with anatomic outcome ( P > .05). A few variables did relate to functional outcome: female or old age statistically correlated with the score of SST, and the size of the tear correlated with the ASES score ( P < .05). The retear was influenced by age, fatty degeneration of the cuff muscles, and the size of tear. Fatty degeneration of the infraspinatus was the most independent predictor of anatomic outcome on multivariate regression analysis. Conclusions Rotator cuff repair brought significant functional improvement. However, the functional outcome did not correlate with the anatomic outcome. The fatty degeneration of the infraspinatus muscle served as an independent predictor of the postoperative integrity of the rotator cuff. Level of Evidence Level IV, prognostic case series.

… the mid-term clinical outcomes (at a mean of 3.2 years after open rotator cuff repair) in a … be considered to contraindicate an attempt at rotator cuff repair if optimal functional recovery was …

Purpose Because recurrent or persistent defects in the rotator cuff after repair are common, we sought to clarify the correlation between structural integrity of the rotator cuff and clinical outcomes through a systematic review of relevant studies. Methods Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials were searched for all literature published from January 1966 to December 2008 that used the key words shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, integrity, healed, magnetic resonance imaging (MRI), computed tomography arthrography (CTA), and ultrasound. The inclusion criteria were studies (Levels I to IV) that reported outcomes after arthroscopic rotator cuff repair in healed and nonhealed repairs based on ultrasound, CTA, and/or MRI. Exclusionary criteria were studies that included open repair or subscapularis repair and studies that did not define outcomes based on healed versus nonhealed but rather used another variable (i.e., repair technique). Data were abstracted from the studies including patient demographics, tear characteristics, surgical procedure, rehabilitation, strength, range of motion, clinical scoring systems, and imaging studies. Results Thirteen studies were included in the final analysis: 5 used ultrasound, 4 used MRI, 2 used CTA, and 2 used combined CTA/MRI for diagnosis of a recurrent tear. Statistical improvement in patients who had an intact cuff at follow‐up was seen in Constant scores in 6 of 9 studies; in University of California, Los Angeles scores in 1 of 2 studies; in American Shoulder and Elbow Surgeons scores in 0 of 3 studies; and in Simple Shoulder Test scores in 0 of 2 studies. Increased range of motion in forward elevation was seen in 2 of 5 studies and increased strength in forward elevation in 5 of 8 studies. Conclusions The results suggest that some important differences in clinical outcomes likely exist between patients with healed and nonhealed rotator cuff repairs. Further study is needed to conclusively define this difference and identify other important prognostic factors related to clinical outcomes. Level of Evidence Level IV, systematic review.

… Literature regarding the outcomes of revision rotator cuff repair is limited. … repair integrity and clinical outcomes for a cohort of patients following revision arthroscopic rotator cuff repair …

… between age and adjusted functional outcomes of rotator cuff repair. Our hypothesis was that age would not affect the anatomical and functional outcomes of rotator cuff repair. …

… The outcome of rotator cuff repairs is … rotator cuff repairs performed by a single shoulder surgeon. The influences of patient characteristics (age, sex, compensation status) on outcome …

… revealed that functional outcomes after arthroscopic rotator cuff repair are comparable with … the repair integrity and clinical outcome following arthroscopic double-row rotator cuff repair …

… of rotator cuff repair tension on surgical outcome. A total of 67 consecutive rotator cuff repairs … our findings that functional outcome is inversely proportional to rotator cuff repair tension. …

Purpose The purpose of this study was to compare the early functional outcome of mini‐open and arthroscopic rotator cuff repair. Methods This was a retrospective study of 128 patients with chronic small‐ and medium‐sized rotator cuff tears who underwent mini‐open rotator cuff repair (MRCR) (n = 63) or arthroscopic rotator cuff repair (ARCR) (n = 65). Data were collected prospectively at baseline 1 to 2 weeks before surgery and at 3 and 6 months after surgery. Patients were identified from a prospectively created database based on the dimensions of the size of the tear as determined intraoperatively. Outcome was assessed via physical examination, visual analog scales (VASs), the Simple Shoulder Test, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Short Form 36 (SF‐36) Health Survey. Changes between baseline and follow‐up were compared. Results All demographic variables and preoperative baseline parameters of the 2 groups were equivalent. At 3 and 6 months, both MRCR and ARCR showed statistically significant improvement in all patient‐derived outcome parameters ( P ≤ .0001) except for three SF‐36 variables. The improvements in the SF‐36 bodily pain score at 3 months postoperatively ( P = .041) and the VAS pain score at 6 months postoperatively ( P = .03) were better for ARCR. All other improvements in patient‐derived parameters were equivalent. Conclusions In our retrospective study we found that the early functional outcomes of MRCR and ARCR of small‐ and medium‐sized rotator cuff tears are nearly equivalent. In light of the purported advantages of ARCR that motivate its popularity, this is an unexpected finding. However, an equally important result of this study was the finding that ARCR was associated with statistically significant improvement in the 3‐month SF‐36 bodily pain score and 6‐month VAS pain score ( P = .041 and .03, respectively). Level of Evidence Level III, retrospective therapeutic comparative study.

… quality plays in the outcome of rotator cuff repairs. There is a strongly negative correlation between increasing muscle degeneration and poorer functional outcomes in both assessment …

… with less favorable outcomes after rotator cuff repair. … regarding rotator cuff repair on their actual self-assessed outcome. … expectations are predictive of the outcome of rotator cuff repair. …

… the outcome after rotator cuff repair has … repair of large and massive rotator cuff tears with use of ultrasound as an imaging modality to determine the postoperative integrity of the repair. …

Purpose To provide a comprehensive review of clinical outcomes and retear rates after patch use in rotator cuff repair, and to determine the differences between available graft types and techniques. Methods A systematic review was conducted from database (PubMed, Medline, Scopus, Embase) inception to January 2015 for English‐language articles reporting outcome data with 9 months' minimum follow‐up. Studies were assessed by 2 reviewers who collected pertinent data, with outcomes combined to generate frequency‐weighted means. Results Twenty‐four studies met the inclusion criteria. The frequency‐weighted mean age was 61.9 years with 35.4 months' follow‐up. The mean improvements in postoperative range of motion in the forward elevation, abduction, external rotation, and internal rotation planes were 58.6°, 66.2°, 16.6°, and 16.1°, respectively, and postoperative abduction strength improved by 3.84 kg. American Shoulder and Elbow Surgeons, University of California–Los Angeles, Constant, Penn, and Oxford scores improved by 39.3, 10.7, 40.8, 34.4, and 17.6, respectively. Augmentation and interposition techniques showed similar improvements in range of motion, strength, and patient‐reported outcomes (PROs), whereas xenografts showed less improvement in PROs compared with other graft types. Studies reported improvements in pain and activities of daily living (ADLs), with greater than 90% overall satisfaction, although few patients (13%) were able to return to preinjury activity. Whereas interposition and augmentation techniques showed similar improvements in pain and ADLs, xenografts showed less improvement in ADLs than other graft types. The overall retear rate was 25%, with rates of 34% and 12% for augmentation and interposition, respectively, and rates of 44%, 23%, and 15% for xenografts, allografts, and synthetic grafts, respectively. Conclusions We report improvements in clinical and functional outcomes, with similar results for augmentation and interposition techniques, whereas xenografts showed less improvement than synthetic grafts and allografts in PROs and ADLs. Retear rates may be lower with the interposition technique or in patients with synthetic grafts or allografts. Level of Evidence Level IV, systematic review of Level II through IV studies.

… have been published that describe prognostic factors after rotator cuff repair; however, to our … review on prognostic factors for successful recovery after arthroscopic rotator cuff repair. …

BACKGROUND This review is one in a series of Cochrane Reviews of interventions for shoulder disorders. OBJECTIVES To synthesise the available evidence regarding the benefits and harms of rotator cuff repair with or without subacromial decompression in the treatment of rotator cuff tears of the shoulder. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and WHO ICRTP registry unrestricted by date or language until 8 January 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) including adults with full-thickness rotator cuff tears and assessing the effect of rotator cuff repair compared to placebo, no treatment, or any other treatment were included. As there were no trials comparing surgery with placebo, the primary comparison was rotator cuff repair with or without subacromial decompression versus non-operative treatment (exercises with or without glucocorticoid injection). Other comparisons were rotator cuff repair and acromioplasty versus rotator cuff repair alone, and rotator cuff repair and subacromial decompression versus subacromial decompression alone. Major outcomes were mean pain, shoulder function, quality of life, participant-rated global assessment of treatment success, adverse events and serious adverse events. The primary endpoint for this review was one year. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. MAIN RESULTS We included nine trials with 1007 participants. Three trials compared rotator cuff repair with subacromial decompression followed by exercises with exercise alone. These trials included 339 participants with full-thickness rotator cuff tears diagnosed with magnetic resonance imaging (MRI) or ultrasound examination. One of the three trials also provided up to three glucocorticoid injections in the exercise group. All surgery groups received tendon repair with subacromial decompression and the postoperative exercises were similar to the exercises provided for the non-operative groups. Five trials (526 participants) compared repair with acromioplasty versus repair alone; and one trial (142 participants) compared repair with subacromial decompression versus subacromial decompression alone. The mean age of trial participants ranged between 56 and 68 years, and females comprised 29% to 56% of the participants. Symptom duration varied from a mean of 10 months up to 28 months. Two trials excluded tears with traumatic onset of symptoms. One trial defined a minimum duration of symptoms of six months and required a trial of conservative therapy before inclusion. The trials included mainly repairable full-thickness supraspinatus tears, six trials specifically excluded tears involving the subscapularis tendon. All trials were at risk of bias for several criteria, most notably due to lack of participant and personnel blinding, but also for other reasons such as unclearly reported methods of random sequence generation or allocation concealment (six trials), incomplete outcome data (three trials), selective reporting (six trials), and other biases (six trials). Our main comparison was subacromial decompression versus non-operative treatment and results are reported for the 12 month follow up. At one year, moderate-certainty evidence (downgraded for bias) from 3 trials with 258 participants indicates that surgery probably provides little or no improvement in pain; mean pain (range 0 to 10, higher scores indicate more pain) was 1.6 points with non-operative treatment and 0.87 points better (0.43 better to 1.30 better) with surgery.. Mean function (zero to 100, higher score indicating better outcome) was 72 points with non-operative treatment and 6 points better (2.43 better to 9.54 better) with surgery (3 trials; 269 participants), low-certainty evidence (downgraded for bias and imprecision). Participant-rated global success rate was 873/1000 after non-operative treatment and 943/1000 after surgery corresponding to (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.96 to 1.22; low-certainty evidence (downgraded for bias and imprecision). Health-related quality of life was 57.5 points (SF-36 mental component score, 0 to 100, higher score indicating better quality of life) with non-operative treatment and 1.3 points worse (4.5 worse to 1.9 better) with surgery (1 trial; 103 participants), low-certainty evidence (downgraded for bias and imprecision). We were unable to estimate the risk of adverse events and serious adverse events as only one event was reported across the trials (very low-certainty evidence; downgraded once due to bias and twice due to very serious imprecision). AUTHORS' CONCLUSIONS At the moment, we are uncertain whether rotator cuff repair surgery provides clinically meaningful benefits to people with symptomatic tears; it may provide little or no clinically important benefits with respect to pain, function, overall quality of life or participant-rated global assessment of treatment success when compared with non-operative treatment. Surgery may not improve shoulder pain or function compared with exercises, with or without glucocorticoid injections. The trials included have methodology concerns and none included a placebo control. They included participants with mostly small degenerative tears involving the supraspinatus tendon and the conclusions of this review may not be applicable to traumatic tears, large tears involving the subscapularis tendon or young people. Furthermore, the trials did not assess if surgery could prevent arthritic changes in long-term follow-up. Further well-designed trials in this area that include a placebo-surgery control group and long follow-up are needed to further increase certainty about the effects of surgery for rotator cuff tears.

A valuable classification system allows for communication among surgeons and/or other investigators and offers information on treatment and prognosis. It provides a means for comparison of epidemiologic data and treatment outcomes. There is no current standard classification for rotator cuff tears. Authors and practicing orthopaedists use a variety of descriptions when communicating about cuff tears. Older classifications do not use 3‐dimensional information derived from the present use of arthroscopy and magnetic resonance imaging. The new geometric classification offers guidance on treatment and prognosis. Type 1, crescent‐shaped tears are repaired end to bone and have a good to excellent prognosis. Type 2, longitudinal (L‐ or U‐shaped) tears are repaired side to side with margin convergence and have a good to excellent prognosis. Type 3, massive contracted tears have coronal and sagittal dimensions greater than 2 × 2 cm on preoperative magnetic resonance imaging; are repaired with interval slides or partial repair; and have a fair to good prognosis. Type 4, rotator cuff arthropathy tears have end‐stage degenerative changes of the glenohumeral joint and have articulation of the humeral head with the undersurface of the acromion; are irreparable; and require arthroplasty if surgery is considered. This classification describes complete tears of the superior and posterior rotator cuff, supraspinatus, infraspinatus, and teres minor. Additional notation can be made regarding the presence of related pathology including tears of the subscapularis, biceps, or labrum; instability or arthritic change of the glenohumeral or acromioclavicular joints; or fatty degeneration of the cuff.

Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

… Graft augmentation may improve healing in massive rotator cuff tears [60] but add significant cost and time to the procedure. The choice of graft is influenced by several factors including …

… failure still occurs in some patients, 3,24,40 and these unexpected healing failures … prognostic factors for rotator cuff healing in patents with only small to medium-sized rotator cuff tears…

… Studies have demonstrated that diabetes mellitus is a definite risk factor for impaired healing after rotator cuff surgery, and those patients with a … are at risk of slow progression over time. …

Purpose: Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain …

… of nonoperatively treated tears as well as the healing potential after repair can be used to aid … the treatment rotator cuff tears. An algorithmic approach to the treatment of rotator cuff tears …

Background: Rehabilitation after rotator cuff repair surgery has been the focus of several clinical trials in the past decade. Many illuminate new evidence with regard to the prognosis of structural and functional success after surgery. Methods: A selective literature search was performed and personal physiotherapeutic and surgical experiences are reported. Results: Post-operative rehabilitation parameters, namely the decision to delay or allow early range of motion after surgery, play a large role in the overall success after surgery. Using a prognosis driven rehabilitation program offers clinicians a means of prescribing optimal rehabilitation parameters while ensuring structural and functional success. This commentary aims to synthesize the evidence in a spectrum of prognostic factors to guide post-operative rehabilitation. Conclusion: The optimal rehabilitation program after rotator cuff repair surgery is debatable; therefore, we suggest using a spectrum of prognostic factors to determine a rehabilitation program suited to ensure structural and functional success, quickly and safely.

… repair of massive rotator cuff tears, to identify prognostic factors affecting rotator cuff healing, … influencing functional outcome in failed rotator cuff healing (primary outcome variable). We …

BACKGROUND There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options has expanded, an overall assessment is required. OBJECTIVES The following were compared to determine which resulted in improved patient-reported function, pain, and re-operation rates for each: 1) Double row (DR) fixation and single row (SR) fixation in arthroscopic cuff repair; 2) Latissimus dorsi transfer (LDT) with lower trapezius transfer (LTT), partial rotator cuff repair; and superior capsular reconstruction (SCR) 3) Early and late surgical intervention. METHODS Medline, Embase, and Cochrane were searched through to April 20, 2021. Additional studies were identified from reviews. The following were included: 1) All English-language randomized trials (RCT) in patients 18 years of age or older comparing SR and DR fixation, 2) observational studies comparing LDT with LTT, partial repair, and SCR, and 3) observational studies comparing early versus late treatment of full-thickness rotator cuff tears. RESULTS A total of 15 RCTs (n=1096 randomized patients) were included in the meta-analysis of SR versus DR fixation. No significant standardized mean differences in function (0.08, 95%CI -0.09 - 0.24) or pain (-0.01, 95CI -0.52 - 0.49) were observed. There was a difference in re-tear rates in favor of DR compared with SR fixation (RR 1.56, 95%CI 1.06 - 2.29). Four studies were included in the systematic review of LDT compared with a surgical control. LDT and partial repair did not reveal any differences in function (-1.12, 95%CI -4.02 - 1.78) upon comparison. A single study compared arthroscopically assisted LDT to LTT and observed a non-statistical difference in the Constant score of 14.7 (95%CI -4.06 - 33.46). A single RCT compared LDT with SCR and revealed a trend toward superiority for the Constant score with SCR with a mean difference of -9.6 (95%CI -19.82 - 0.62). Comparison of early versus late treatment revealed a paucity of comparative studies with varying definitions of 'early' and 'late' treatment which made meaningful interpretation of the results difficult. CONCLUSION DR fixation leads to similar improvement in function and pain compared with SR fixation and results in a higher healing rate. LDT transfer yields similar results to partial repair, LTT, and SCR in functional outcomes. Further study is required to determine the optimal timing of treatment and to increase confidence in these findings. Future trials of high methodological quality comparing LDT with LTT and SCR are required.

… rotator cuff tear. Our hypothesis is that there is a period in which a rotator cuff can be repaired after an acute loss of shoulder … , which will allow for pain relief and improvement in function. …

… All patients who had undergone a rotator cuff repair at our institution from July 2007 to June 2011 were identified by means of a search for CPT (Current Procedural Terminology) codes …

… are associated with shoulder strength and … shoulder function after rotator cuff repair, our central hypothesis was that dynamic joint function is not completely restored by rotator cuff repair, …

… rotator cuff after open repair have been controversial and have left unsettled the correlation between the integrity of the cuff and the shoulder function (… to evaluate shoulder function after …

… Because none of the three systems is superior for describing shoulder function after rotator cuff repair, the simplest and most practical assessment tool should be used. The data for …

Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.

Forty patients underwent surgery by a single surgeon for chronic, symptomatic, full-thickness rotator cuff defects. The study evaluated preoperative and intraoperative factors that influence postoperative outcome. The study also correlated objective measures of shoulder function with postoperative symptoms, patient satisfaction, and disability. Follow-up history and physical examination and strength measurements were performed at 2 years after surgery by three independent observers. There were 88% good or excellent results. Postscores correlated most closely with preoperative tear size. Postoperative Constant scores also correlated significantly with the patient's subjective rating of the end result. Preoperative cuff tear size also correlated with the presence of postoperative fatigue symptoms and objective measures of shoulder strength. Preoperative cuff tear size strongly correlated with other prognostic factors including the quality of the tendon tissue, the difficulty for tendon mobilization, and the presence of a rupture of the long head of the biceps. Together these factors adversely affect postoperative function, patient satisfaction, and overall shoulder score. Neither premorbid activity level nor the presence of a worker's compensation claim adversely affected the postoperative Constant score. The premorbid activity level significantly influenced the postoperative disability rating and the ability to return to work. All patients who were gainfully employed before surgery returned to employment after surgery, although in some patients at a lesser activity level.

Objective We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function. Methods This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research. Results This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance. Conclusions The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient’s ability to meet predetermined clinical goals or criteria may be a better option.

… examiners who used Constant’s functional score to evaluate shoulder function, and who were not aware of the type of tear found operatively or of the sonographic findings. The overall …

… the structural integrity of rotator cuff repair and the clinical … function and structural integrity of the rotator cuff after repair. … the hypothesis that shoulder function and imaging studies do …

… tears or the outcome of primary rotator cuff repair include the following: (1) rotator cuff tear … rotator cuff tears from multiple community practices, (2) to determine self-assessed functional …

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up (P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

BACKGROUND Many poor outcomes after arthroscopic rotator cuff (RC) repair relate to failure of tendon healing. The purposes of this study were to provide a better understanding of the magnetic resonance arthrography (MRA) characteristics of the RC tendon repair site after arthroscopic RC repair and to examine how these findings influence patient-reported outcome measures (PROMs) and the presence of persistent symptoms. METHODS We reviewed 48 shoulders (13 female and 35 male patients; average age, 53.8 years) at a minimum of 6 months (average, 11.4 months) after arthroscopic RC repair (average tear size, 2.2 cm). All patients completed PROMs and underwent MRA assessment. Detailed analysis of the RC repair site was undertaken, with findings correlated with clinical outcomes and PROMs. RESULTS The average preoperative American Shoulder and Elbow Surgeons (ASES) score of 39.5 improved to 92.8 (P < .001). All but 6 patients (87.5%) had increased signal intensity of the involved tendon, with interstitial splits and/or delamination in 65.6%. These changes had no effect on PROMs or patient satisfaction. Significant partial-thickness tears (>50%) were observed in 7 patients (14.6%), with no effect on outcomes (average ASES score of 95.2 and satisfaction score of 9). There were 2 recurrent full-thickness tears (4.2%), and 4 patients (8.3%) had a failure in continuity. The average ASES score in these 6 cases of failure was 76 (P < .001). CONCLUSIONS Structural abnormalities on MRA are common after RC repair but do not always result in clinical failure. However, our results suggest that an ASES score of less than 80 may be useful when considering postoperative imaging, especially in a patient with ongoing pain more than 6 months after surgery.

… All studies assessing rotator cuff tear and repair outcomes in … assessing tendon integrity was noted for each study. This included any use of imaging to assess the status of tendon repair …

Background: Rotator cuff repair (RCR) leads to improved patient outcomes, which may or may not coincide with biological healing of the tendon. Many patient factors may play a role in subjective and objective patient outcomes of surgery. Purpose: To evaluate the effect of various patient factors and tendon healing on range of motion, strength, and functional outcomes after arthroscopic RCR. Study Design: Case-control study; Level of evidence, 3. Methods: We reviewed patients who underwent arthroscopic RCR. Postoperative endpoints included physical examination, repeat magnetic resonance imaging (MRI), and patient-reported outcome measures. The Short Form–36 (SF-36) was also completed at enrollment. Physical examination included range of motion and strength testing. Preoperative tear characteristics and postoperative healing on MRI were recorded. Associations between these characteristics and rotator cuff healing were determined. Multivariate models investigated factors affecting healing and final outcomes. Results: A total of 81 patients had MRI before and a minimum of 1 year after RCR. Patient-reported outcomes were available for all patients at mean 2.7 years (range, 1-7.7 years) after RCR. Seventy-five patients had physical examination data. Patients were less likely to heal if they had tears involving multiple tendons (P = .037), tears >2.2 cm (P = .037), tears retracted >2.0 cm (P = .006), and tears with cumulative Goutallier grade ≥3 (P = .003). Patients who healed were stronger on manual muscle testing in forward elevation (P < .001) and external rotation (P = .005) and on forward elevation isometric testing (P = .033), and they reported better patient-reported outcomes (P ≤ .01) at final follow-up. In multivariate models, tendon healing was associated with less pain (P = .019) and better patient-reported outcomes (all P ≤ .006). Lower SF-36 mental component summary (MCS) score was associated with increased pain (P = .025) and lower final American Shoulder and Elbow Surgeons score (P = .035), independent of healing status. Conclusion: Larger, more retracted tears with greater fatty infiltration are less likely to heal per MRI. Patients who do not heal are weaker and have worse patient-reported outcome measures. Lower SF-36 MCS score was associated with poorer patient-reported outcomes independent of tendon healing.

Background: Scoring systems integrating possible prognostic factors and predicting rotator cuff healing after surgical repair could provide valuable information for clinical practice. Purpose: To determine the prognostic factors predictive of rotator cuff healing after surgical repair and to integrate these factors into a scoring system. Study Design: Case-control study; Level of evidence, 3. Methods: The authors reviewed the records of 603 patients who, at least 12 months after primary rotator cuff repair by a single surgeon, had magnetic resonance imaging or computed tomographic arthrography to assess repair integrity. The mean age at the time of surgery was 60 years (range, 39-81 years), and 378 patients were women (62.7%). Previous known or suggested factors affecting cuff integrity were analyzed through univariate and multivariate analyses. Factors identified in the multivariate analysis were integrated in a scoring system based on odds ratios (ORs). Results: The overall healing failure rate was 24%. The following independent risk factors were identified in the multivariate analysis: age >70 years at the time of surgery (P = .003, OR = 2.71), size of the tear in anteroposterior dimension (P = .033, OR = 1.94) and retraction (P = .000, OR = 4.56), fatty infiltration of infraspinatus exceeding grade 2 (P = .001, OR = 2.91), low bone mineral density (T score ≤ –2.5, P = .04, OR = 1.95), and high level of work activity (P = .036, OR = 2.18). A 15-point scoring system comprised the following: 4 points for retraction; 3 points for fatty infiltration of infraspinatus; and 2 points for anteroposterior tear size, age, bone mineral density, and work activity, weighted according to multivariate analysis ORs. Patients with ≤4 points had a 6.0% healing failure rate, and those with ≥5 and ≥10 points had 55.2% and 86.2% healing failure rates, respectively. Conclusion: A numerical scoring system including significant clinical and radiological factors was designed to predict healing of the rotator cuff after surgical repair. This scoring system helped predict the adequacy of the repair and assist in deciding the appropriate treatment options.

… To test this hypothesis, we carried out a prospective, … on tendon-to-bone healing after surgical repair of the rotator cuff … time of rotator cuff tendon repair did not improve tendon healing, …

… Because the primary objective of the study was to assess factors affecting tendon healing and not clinical outcomes, the time point of 6 months was chosen. The 6-month minimum was …

Background: Failure of repair of large and massive rotator cuff tears is a challenging problem within orthopaedics. Poor tendon tissue and vascularity are known causes for failure of rotator cuff repairs. Purpose: To assess the safety, outcomes, and healing rates when large and massive rotator cuff repairs are augmented with a bioinductive collagen scaffold patch in a proof-of-principle design. Study Design: Case series; Level of evidence, 4. Methods: Twenty-three patients undergoing repair of full-thickness large (2-tendon) or massive (3-tendon) rotator cuff tears augmented with a bioinductive collagen patch were enrolled in a prospective single-arm proof-of-principle study. No partial repairs were performed, and a complete rotator cuff repair was successfully achieved in each case. Sixteen patients underwent revision rotator cuff repairs versus 7 primary repairs. Safety was determined by any implant-related adverse event. A single magnetic resonance imaging (MRI) scan was utilized to confirm tendon healing and thickness at a minimum of 6 months postoperatively. Postoperative ultrasound (US) was used in office by the treating surgeon to assess tendon thickness at 3-, 6-, 12-, and 24-month intervals. American Shoulder and Elbow Surgeons (ASES) scores were collected at final follow-up. Results: Overall, a 96% (22 of 23) healing rate was confirmed on US and MRI. However, incidence of treatment clinical failure was 9% (2 of 23), as 1 patient’s tendon healed but eventually underwent additional surgery. There were no adverse events attributed to the implant reported. Final US rotator cuff thickness was 7.28 ± 0.85 mm (mean ± SD), and final MRI rotator cuff thickness was 5.13 ± 1.06 mm. The mean ASES score at final follow-up was 82.87 ± 16.68 (range, 53.33-100). Conclusion: No complications attributed to the implant were reported, and new tendon formation was apparent on US and MRI, with relatively high healing rates at 2-year follow-up. Arthroscopic application of this bioinductive collagen scaffold when combined with rotator cuff repair is a safe and effective treatment for healing of large and massive rotator cuff repairs.

… After intra-articular assessment of the cuff repair, we assessed the quality of repair and the contact between bone and tendon on a bursal view, passing a probe through the posterior …

… This work is the first prospective single surgeon study comparing MRI and US to assess tendon healing after arthroscopic rotator cuff repair. The number of patients is substantial and …

… the shoulder, evidence of rotator cuff tear on MRI examination, lesion of at least 1 tendon on arthroscopic cuff examination, no previous intra-articular injection therapy, lack of shoulder …

… after arthroscopic rotator cuff repair. The primary outcome assessed was tendon healing in the repaired cuff. Secondary outcome measures were range of motion (ROM) and American …

Purpose The aim of this study was to assess tendon healing and clinical results of rotator cuff tears (RCTs) repaired arthroscopically in patients aged 65 years or older. Methods Between January 2001 and December 2004, 88 patients with a mean age of 70 years (range, 65 to 85 years) had arthroscopic RCT repair. The repair was performed on 54 women (61%). The dominant arm was involved in 72 patients (82%). RCT included more than 2 tendons in 45 cases. Functional outcomes were assessed by use of the Constant score and Simple Shoulder Test. Tendon healing was estimated by use of a computed tomography (CT) arthrogram, which was obtained 6 months postoperatively, and was classified into 3 categories: stage 1, watertight and anatomic healing; stage 2, watertight and partial healing; and stage 3, not watertight and retear. Results The mean duration of follow‐up was 41 months (range, 24 to 77 months). The mean clinical outcome scores all improved significantly at the time of the final follow‐up ( P &lt; .01). Computed tomography arthrogram imaging showed 27 shoulders with a stage 1 repair, 20 with a stage 2 repair, and 34 with a stage 3 repair. The retear rate was 42% (34 of 81). The patients with tendon healing stage 1 or 2 had a significantly superior functional outcome in terms of overall scores and strength compared with the stage 3 repairs ( P &lt; .01). In our study we had 39 isolated supraspinatus tears (small or medium tears); 11 (28.9%) had a retear (stage 3). Conclusions Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement. Our data suggest that arthroscopic repair can be considered successful for the older patient specifically when the tear is limited to the supraspinatus tendon. Level of Evidence Level IV, therapeutic case series.

… Our findings on rotator cuff healing contrast the results reported in a meta-analysis by Warth et al, 84 which found no significant difference in VAS score improvement between PRP-…

… The purpose of this study was to prospectively assess the integrity of tendons that … rotator cuff muscles are affected by the tendon repair and to correlate the structural results of the repair …

Objective To evaluate the correlation between the UCLA and Constant-Murley scores in the surgical treatment of rotator cuff tears and proximal humeral fractures (PHF). Methods Retrospective study evaluating patients submitted to arthroscopic rotator cuff repair and surgical treatment of PHF with 2-year follow-up. Patients were evaluated by the UCLA and Constant-Murley scores in the preoperative period for the rotator cuff repairs, and 3, 6, 12 and 24 months after surgery for both diagnoses. Pearson's correlation coefficient (r) was calculated to measure the degree of correlation between the two clinical scales. Results We evaluated 109 patients: 54 with rotator cuff tear and 55 with PHF. Twenty-four months after surgical treatment, the scores according to the UCLA and Constant-Murley scores were 32.6 ± 4.0 and 85.0 ± 12.0 for the rotator cuff tears and 30.3 ± 5.3 and 73.8 ± 13.9 for the PHF, demonstrating significant improvements in both, in relation to the initial evaluation (p < 0.001). The scales demonstrated high correlation (r = 0.88, p < 0.001). The scores obtained in the two scales showed high or very high correlation in all the postoperative clinical evaluations (r = 0.79–0.91, p < 0.001). The correlation was high in the preoperative evaluation (r = 0.73, p < 0.001). Conclusion The UCLA and Constant-Murley scores presented high or very high correlation in the evaluation of surgical treatment of rotator cuff tears and PHF. The correlation in the preoperative evaluation was high.

Aim To determine the Minimal Clinically Important Difference (MCID) for Constant-Murley score (CMS), University of California Los Angeles (UCLA) shoulder score, and Oxford Shoulder Scores (OSS) after arthroscopic rotator cuff (RC) repairs. Material and methods 306 patients were followed up for 24-month. MCID for CMS, UCLA and OSS were determined using simple linear regression according to patient satisfaction and expectation fulfilment. Results The following MCID were identified:12-month: CMS 6.7, UCLA 3.0, OSS 3.3.24-month: CMS 6.3, UCLA 2.9, OSS 2.7. Conclusions The various MCID could assist in meaningful interpretation of these scores and to power future comparative studies. Level of evidence III.

… between total score on the CMS and the Western Ontario Rotator Cuff Index (WORC), the … Constant-Murley score (CMS) is one of the most commonly used international shoulder scoring …

… use of the Constant-Murley score for specific clinical and research applications but underscores the need for greater standardization and precaution when interpreting scores. Methods …

Background: Rotator cuff repair (RCR) is a well-studied procedure. However, the impact of patient sex on outcomes after RCR has not been well studied. Purpose: To conduct a systematic review and meta-analysis of sex-based differences in outcomes after RCR and to record what proportion of studies examined this as a primary or secondary purpose. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using multiple databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, performed on humans, consisted of patients who underwent RCR, evaluated at least 1 of the selected outcomes based on patient sex, and had statistical analysis available for their sex-based claim. Excluded were case reports, review studies, systematic reviews, cadaveric studies, and studies that did not report at least 1 sex-specific outcome or included certain other injuries associated with a rotator cuff injury. Results: Of 9998 studies screened and 1283 full-text studies reviewed, 11 (0.11%) studies with 2860 patients (1549 male and 1329 female) were included for quantitative analysis. None of these 11 studies examined the impact of patient sex on outcomes after RCR as a primary outcome. Postoperative Constant-Murley scores were analyzed for 7 studies. Male patients had a postoperative Constant-Murley score of 76.77 ± 15.94, while female patients had a postoperative Constant-Murley score of 69.88 ± 17.02. The random-effects model showed that male patients had significantly higher scores than female patients, with a mean difference of 7.33 (95% CI, 5.21-9.46; P < .0001). Analysis of retear rates in 5 studies indicated that there was no difference in the retear rate between sexes (odds ratio, 0.91 [95% CI, 0.49-1.67]). Conclusion: Female patients had lower postoperative Constant-Murley scores compared with male patients, but there was no difference in the retear rate. However, these results were based on an analysis of only 11 studies. The paucity of studies examining the impact of sex suggests that more research is needed on the impact of patient sex on outcomes after RCR.

… the Constant–Murley, DASH and OSS scoring systems preoperatively (P < 0.05), reflecting a difference in tear severity. Arthroscopic rotator cuff repair is … The Constant–Murley score was …

Background: Massive rotator cuff tears are challenging to treat, with few or no studies on long-term outcomes of repair. The purpose of this study was to report 10-year outcomes following repair of massive posterosuperior rotator cuff tears, with and without extension into the subscapularis, and to determine prognostic factors that could influence clinical scores and retear rates. Methods: The records of 234 patients who underwent repair of a massive posterosuperior rotator cuff tear at a total of 15 centers were retrieved. Patients were asked to return for evaluation at 10 years; 78 patients could not be contacted, 7 had died, and 19 had undergone a reoperation. A total of 130 patients (68% men) with a mean age (and standard deviation) of 56.1 ± 7.7 years (range, 26 to 79 years) were evaluated clinically, and 102 of them were also evaluated using magnetic resonance imaging (MRI). The tear was confined to the supraspinatus and infraspinatus tendons in 94 shoulders and also involved the superior portion of the subscapularis in 36 shoulders. Univariable and multivariable regressions were performed to determine whether 10-year total Constant-Murley scores and repair integrity were associated with patient characteristics, tear patterns, or repair techniques. Results: In the study cohort, complications were noted in 14 shoulders (11%) (stiffness in 10 and infection in 4). For the 130 shoulders evaluated clinically, the mean total Constant-Murley score improved from 53.1 ± 15.9 (range, 14 to 83) preoperatively to 78.5 ± 11.3 (range, 36 to 98) at 10 years. Of the 102 shoulders evaluated using MRI, 32 had a retear (Sugaya type IV or V). Of the 19 shoulders that underwent a reoperation (excluded from the study cohort), 9 had a retear. The overall prevalence of retears was 34%. Multivariable regression analysis revealed a significant association between the 10-year Constant-Murley score and preoperative retraction of the infraspinatus tendon, but no association between retears and any of the variables. Involvement of the subscapularis had no significant effect on preoperative or postoperative Constant-Murley scores or retear rates. Conclusions: Patients who had repair of a massive posterosuperior rotator cuff tear maintained considerable improvements in clinical and radiographic outcomes at 10 years. Partial concomitant tears of the subscapularis did not affect the total postoperative Constant-Murley scores or retear rates. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

… In our study, the mean change in the Constant score was not affected by severity of the rotator cuff tear, working status of the patient, or history of trauma. This suggests that the estimate …

Background Arthroscopic revision rotator cuff repairs (RCRs) exhibit lower healing rates and inferior outcomes compared to primary repairs. There is limited evidence regarding the use of bioaugmentation in the setting of revision RCRs. Autologous conditioned plasma (ACP) is a promising adjunct that has been shown to improve healing rates and patient-reported outcomes (PROs) in the primary setting. In addition, bioinductive patches such as collagen bovine patches have become a popular adjunct for stimulating healing in the primary setting. The aim of this study is to assess the outcomes after use of ACP and collagen bovine patch augmentation for revision arthroscopic RCR. We hypothesized improved PROs and higher healing rates would be observed with bioaugmentation for revision repair compared to without. Methods This was an institutional review board–approved, retrospective case-control study from 2 fellowship-trained surgeons that included all consecutive patients undergoing arthroscopic revision RCR from 2010 to 2021. Reconstruction such as superior capsular reconstruction, partial revision repair, and less than 1-year follow-up were excluded. The bioaugmentation cohort received ACP and/or collagen bovine patch at the time of revision repair. PROs were collected from all patients including American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES), visual analog scale for pain (VAS), Brophy score, and Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical scores. Failure of revision RCR was defined as an ASES postoperative total score less than 60 or a symptomatic retear confirmed on magnetic resonance imaging. Student’s t-test was used for all comparisons of continuous variables. Chi-squared test used for comparison of all categorical variables. Statistical significance was set at <0.05. Results Thirty-eight patients met inclusion criteria with average follow-up of 3.5 ± 1.7 years. There was no significant difference in follow-up between patients with and without bioaugmentation. Of the 38 patients, 14 patients met failure criteria. There was no significant difference in the rate of failure between the bioaugmentation cohort (6/19, 31.6%) vs. patients who did not receive bioaugmentation (8/19, 42.1%) (P = .74). In addition, no significant differences were identified for ASES (64.6 ± 20.1 vs. 57.5 ± 17.2, P = .32), Brophy (6.4 ± 5.2 vs. 6.0 ± 4.1, P = .84), PROMIS Mental (13.4 ± 3.9 vs. 11.7 ± 3.2), or PROMIS Physical (12.8 ± 3.1 vs. 11.9 ± 3.2) scores between the bioaugmentation vs. no bioaugmentation groups. Conclusion Bioaugmentation with a bioinductive collagen patch or ACP demonstrated similar failure and PROs compared to without bioaugmentation in the setting of revision RCR.

Purpose/introduction Over the last decades, there has been increasing interest in biological stimulation or bioaugmentation after rotator cuff repair. So far, there is no consensus on the appropriate composition of biologicals or which patients would benefit most, and moreover, these biologicals are often expensive. However, there are other, non-pharmacological strategies that are also believed to achieve biological stimulation. This randomised controlled trial evaluates the possible cumulative effect of pragmatic application of cryobiomodulation, photobiomodulation and electrobiomodulation—collectively called biomodulation—on the bone-to-tendon healing process after rotator cuff repair. Methods In this randomised, controlled proof of concept study, 146 patients undergoing arthroscopic repair of a full thickness posterosuperior or anterosuperior rotator cuff tear will be 1:1 randomly assigned to either a control group or to the additional biomodulation protocol group. The adjuvant biomodulation protocol consists of seven self-applicable therapies and will be administered during the first 6 weeks after surgery. Primary outcome will be healing of the rotator cuff as evaluated by the Sugaya classification on MRI at 1-year postoperatively. Ethics and dissemination This study has been accepted by the National Ethical Review Board CPP Sud-Est IV in France and has been registered at Clinicaltrials.gov. The results of this study will be published in a peer-reviewed journal. Trial registration number NCT04618484.

Background/Objectives: Rotator cuff repair (RCR) is a common orthopedic procedure, with healing outcomes strongly influenced by patient-specific factors such as tissue quality, tear characteristics, and biological healing potential. Bioinductive collagen implants have shown great results in enhancing tendon healing and reducing retear rate. This study aimed to evaluate the clinical and imaging outcomes of RCR augmented with a xeno-derived collagen membrane over 24 months and to assess complications or implant failures. Methods: Patients underwent arthroscopic RCR using anchors (single or double-row) with additional xeno-derived matrix augmentation. The study included patients older than 40 years with full-thickness supraspinatus and/or infraspinatus tendon tears (DeOrio–Cofield grade 3–4) who were candidates for arthroscopic rotator cuff repair and provided informed consent. Clinical outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Visual Analogue Score (VAS) at baseline, 3, 6, 12, and 24 months. MRI was performed preoperatively and at 24 months to assess tendon thickness. Results: All scores improved significantly. CMS increased from 16.3 ± 4.1 to 82.9 ± 5.8, VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8, and DASH improved from 70.3 ± 6.4 to 12.4 ± 4.5 (p < 0.05). Tendon thickness in the supraspinatus (T3) increased from 4.2 ± 0.9 mm to 6.8 ± 1.2 mm (p < 0.05). Retear rate was 7.55%, with no major complications. Conclusions: The bioinductive collagen implant showed notable results in improving tendon thickness, healing, and excellent clinical outcomes in RCR, without membrane-related complications. The study was designed as a prospective single-arm case series without a control group and that was the main limitation; The absence of adverse reactions in this cohort further supports the favorable safety profile of this implant in the present study population.

Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients’ motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.

Background: Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing. Purpose: To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively. Results: A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively (P < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; P = .04) and SANE (84.1 vs 50.5; P = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus (P = .024). Conclusion: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.

BACKGROUND Clinical studies support that augmenting rotator cuff repair through the induction of new host tissue can prevent gapping or re-tear by increasing tendon thickness and strength. To date, most implants for augmentation have focused solely on biologic healing or mechanical reinforcement of the repair. This preclinical study evaluated the short- and long-term performance of a biocomposite (type I collagen and poly-L-lactic acid) scaffold to support the rapid proliferation, maturation, and remodeling of new host tissue in a large animal rotator cuff repair model. METHODS A full-thickness detachment of the central third of infraspinatus tendon (IST) was created and repaired in 25 sheep using a double row suture bridge technique augmented with a biocomposite scaffold. Animals were euthanized at 6, 12, 26, and 52 weeks for assessment of tendon thickness and maturation via MRI and histology (n=3 sheep per time point). Mechanical testing was performed at 6-weeks (n=7 sheep) and 12-weeks (n= 6 sheep) and compared to the non-operative controls. RESULTS All animals recovered well following surgery, and no adverse events were encountered during the in vivo phase out to 52 weeks. Histology revealed a progressive integration and incorporation of new fibrous tissue within, above, and below the scaffold at 6-weeks that continued to mature and remodel with time out to 52-weeks. Enthesis healing improved with time as the repaired infraspinatus tendon healed to the humeral attachment. MRI findings showed an 180% increase in tendon thickness at all time points, compared to the non-operative control. The ultimate load (N) of the repairs significantly increased between 0, 6, and 12 weeks (P <.01). CONCLUSIONS This study demonstrated the collagen-PLLA biocomposite scaffold increased the thickness of a repaired rotator cuff tendon through the rapid induction of host generated connective tissue at all timepoints. Histology confirmed the bioinductivity of organized fibrous tissue within, above and below the scaffold. Progressive healing and maturation of the enthesis was observed with MRI and histology out to 52-weeks, without any adverse reactions. The combination of biologic healing and mechanical reinforcement in a single implant provides an exciting solution for rotator cuff augmentation.

Rotator cuff repairs demonstrate variable success, with reported retear rates from 4% to 94%, and the highest retear rates are associated with large and massive tears. Scaffolds are an augmentation strategy for repairs aimed at fortifying healing of the bone-tendon junction by facilitating cellular repopulation and marrow elements at the tendon footprint. The Rotium nanofiber scaffold (Atreon Orthopedics, Columbus, OH) is an interpositional nanofiber scaffold that is compressed between the repaired rotator cuff and the footprint on the greater tuberosity. The bioabsorbable synthetic profile replicates the native tendinous attachment with minimal risk of immunogenicity and with resorption at 3 to 4 months. This article describes a preparation and implantation strategy to augment arthroscopic rotator cuff repair, adding minimal surgical time.

Rotator cuff injuries are a leading cause of shoulder dysfunction, where bio‐inductive collagen implants have demonstrated promising results in promoting tendon regeneration and reducing retear rates. However, existing evidence lacks consistent evaluation across varying follow‐up durations, while the specific factors influencing their safety and effectiveness remain undetermined. This study aims to evaluate the quality of evidence regarding the safety, efficacy, and impact factors of applying the resorbable bio‐inductive collagen implant clinically to repair rotator cuff injuries.

Background: The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair. Purpose/Hypothesis: To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status. Results: At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores (P < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively (P < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch. Conclusion: Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.

The subacromial bursa is located below the acromion, coracoacromial ligament, and deltoid deep fascia, above the rotator cuff and greater tuberosity of the humerus, and plays a crucial role in physiological processes such as exercise and pathological processes of rotator cuff diseases. The subacromial bursa is associated with inflammatory pain in patients with rotator cuff disease. Removing the bursa during surgery and intra-articular drug injection can both relieve this pain to some degree. Resection of the subacromial bursa improves intraoperative visualization and may loosen an already stiff shoulder joint; however, excessive resection appears to result in more severe adhesion. Current evidence suggests that the subacromial bursa is a source of reparative cytokines and mesenchymal stem cells that may contribute to and enhance the healing of the injured rotator cuff and improve prognosis. Research studies related to the utilization of the subacromial bursa for bioaugmentation is ongoing and shows potential to promote patient recovery. Preservation or bioaugmentation with the subacromial bursa during rotator cuff surgery might lead to a better prognosis, but there is not yet sufficient evidence to prove this.

To compare the clinical and radiographic outcomes after full-thickness RC repair with and without performing augmentation with a bioinductive collagen implant (BCI). Consecutive patients who underwent primary repair of a full-thickness supraspinatus tear between 05/2021 and 11/2023 were retrospectively identified. Patients at elevated risk for retear were defined by biological, radiographic, and intraoperative risk factors. Those who underwent repair with or without concomitant augmentation using a BCI and who had both clinical and radiographic follow-up at 1 year postoperatively were matched in a 1:1 ratio according to age, sex, body mass index, tear size, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. Range of motion (ROM) as well as patient-reported outcome measures (Auto-Constant-Score (CS), American Shoulder and Elbow Surgeons (ASES) Score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) for pain) were recorded. Magnetic resonance imaging performed at 1 year postoperatively was analyzed and the presence of retear was recorded. In total, 149 patients with a radiographic and clinical follow-up at 1 year postoperatively were identified. Of these, 23 patients with BCI augmentation were matched to 23 patients without placement of BCI (48% female, 59.2 ± 8.4 years at surgery). A retear occurred in 5 patients (21.7%) in the BCI augmentation group and in 3 patients (13.0%) in the control group (p = 0.72). No significant difference was reported regarding the CS (77 [71–83] vs. 76 [63–81], p = 0.5), ASES Score (92 [82–98] vs. 90 [84–95], p = 0.8), SSV (90 [80–100] vs. 90 [88–95], p = 0.9), VAS for pain (p = 0.74), or ROM between the groups. In this retrospective matched cohort of patients at elevated risk for retear, augmentation of full-thickness RC repair with a BCI was not associated with a reduced retear rate. Moreover, no significant differences regarding clinical and functional outcome were found between the two groups. III – Retrospective case series with a matched control group.

… sheep model is a reasonable one for testing the initial strength of rotator cuff repair. … to provide a scaffold for the healing of tendinous tissue in the shoulder and elsewhere in the body. …

Tendon defect is one of the common clinical diseases related to the growing population mean age and the number of athletes. Due to an increasing demand for tendon repair surgical interventions, several tendon augmentation products, capable of guaranteeing the necessary biological and visco-elasticity properties and mechanical support, have been developed. In this regard, commercially available products may be grouped into three main categories: (i) natural, (ii) synthetic, and (iii) hybrid biomaterial-based products. Firstly, to better define the research area of this work, common search engines were employed to acquire information from reports or website portfolios of important competitors in the global tendon repair market. Secondly, public registries and bibliographic databases were also employed to analyse data from registered clinical trials and published clinical studies performed to evaluate the safety and efficacy of each product. Ten new products have been launched on the market in the last fifteen years: advantages, disadvantages, and future perspectives regarding their use for tendon augmentation treatment are discussed. Although hybrid biomaterial-based products may be considered as more oriented to the new frontiers of tendon augmentation technology, future improvements, especially focused on both mechanical properties and biocompatibility, are needed. However, scientific innovations must navigate convoluted clinical regulatory paths, which, due to high costs for investors, long development timelines, and funding shortages, hinder the translation of many scientific discoveries into routine clinical practice.

Currently, although most evidence suggests that surgery is effective in treating symptomatic partial-thickness rotator cuff tears in patients with failure of nonoperative management and with a tear of more than 50% of the tendon thickness, there is little consensus on the best method of repair. Some surgeons would advocate completing the tear and repairing it, whereas others would advocate performing in situ repair. In our opinion, it is important to also consider treating the long head of the biceps tendon, which is frequently a source of pain at the time of or after surgery.

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2‐year follow‐up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side‐to‐side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open‐mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco‐humeral ligament, were performed arthroscopically as needed. All repairs were performed using O‐PDS or 1‐PDS suture and a 7‐mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (&lt; 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O‐PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1‐ PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

… repairs were single row and received an arthroscopic subacromial decompression. We identified 33 all-arthroscopic rotator cuff repairs for follow-up … Angeles score at follow-up was 31.8…

… at short-term follow-up, arthroscopic rotator cuff repair results in significant … follow-up compare favorably with those reported in other isolated series of all arthroscopic rotator cuff repairs …

PURPOSE To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up. METHODS Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated. RESULTS Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up. CONCLUSIONS In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.

… The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear. In the subgroup of grade 1 and 2 tears, with less retraction, SER in the PRP group was …

Purpose To compare the clinical outcomes of patients undergoing all‐arthroscopic versus mini‐open rotator cuff repair. In addition, ultrasound was used to assess the integrity of the repair. Methods A total of 38 patients who had undergone all‐arthroscopic repair and 33 patients who had undergone mini‐open repair with minimum 2‐year follow‐up were evaluated. All patients completed the American Shoulder and Elbow Surgeons’ Scoring Survey (ASES), the Simple Shoulder Test, the L'Insalata Scoring Survey, and visual analog scales for pain. Physical examination, including strength testing and ultrasound evaluation to determine the integrity of the rotator cuff, was performed. Results No statistical difference in ASES scores was noted between patients who had all‐arthroscopic repair versus mini‐open repair, and 24% of all‐arthroscopic repairs and 27% of mini‐open repairs showed recurrent defects on ultrasound at follow‐up. This difference was not statistically significant. Patients with an original tear larger than 3 cm were 7 times more likely to have a recurrent defect at follow‐up. Patients with persistent defects had statistically significant deficits in strength on forward elevation and external rotation when compared with those with a normal shoulder. However, no difference was observed with regard to pain or outcome scores between patients with intact repairs and those with persistent defects. Conclusions No difference in clinical outcomes was found between patients with rotator cuffs repaired arthroscopically and those repaired with use of a mini‐open technique. Level of Evidence Level III, retrospective comparative study.

Background: Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. Purpose: To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. Results: A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. Conclusion: RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.

… and ultimate effectiveness of arthroscopic repair techniques for large tears. We present the clinical follow-up and repair integrity of an arthroscopic technique that uses 2 rows of fixation. …

… The charts of a total of 283 patients, who underwent arthroscopic rotator cuff repair performed by 2 senior orthopaedic surgeons (WA, BK) at our institution between June 2003 and …

… The purpose of this review was to analyze all the available articles reporting outcomes associated with the arthroscopic treatment of RCT, with a minimum follow-up of 5 years. …

Purpose: The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. Type of Study: Prospective cohort study. Methods: Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow Society (ASES) index, visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction (Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today?). The null hypothesis that was tested was that there was no difference between the preoperative and postoperative outcomes. The 37 patients were divided, by cohort design, into 2 groups; massive anterosuperior (AS; subscapularis, supraspinatus, and infraspinatus with or without the teres minor) and massive posterosuperior (PS; supraspinatus and infraspinatus, with or without the teres minor) tears. Additionally, the null hypothesis that there was no difference between outcomes for massive AS and massive PS subgroups was tested. Results: There was no statistically significant difference between either subset of massive rotator cuff tears with respect to preoperative and postoperative outcomes. The null hypothesis was supported for between groups. All but 2 patients said that they would undergo surgery again to achieve the postoperative state. Conclusions: The arthroscopic repair of massive rotator cuff tears is effective for decreasing pain and improving the functional status of the shoulder for most patients. Complete coverage was achieved in 78% of the patients at the time of surgery. A subset of patients who did not have complete coverage or coverage at a second setting showed similar outcomes as those with full coverage. The patient satisfaction rate was 95%.

… at the time of rotator cuff repair has significantly increased … of patients undergoing arthroscopic rotator cuff repair with and … after arthroscopic repair of full-thickness rotator cuff tears in …

… the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. … Another limitation is the 22% patient drop-out rate from initial surgery to final follow-up. …

Background: Arthroscopic rotator cuff repair (RCR) with suture anchor–based fixation techniques has replaced former open and mini-open approaches. Nevertheless, long-term studies are scarce, and lack of knowledge exists about whether single-row (SR) or double-row (DR) methods are superior in clinical and anatomic results. Purpose: To analyze long-term results after arthroscopic RCR in patients with symptomatic rotator cuff tears and to compare functional and radiographic outcomes between SR and DR repair techniques at least 10 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2005 and 2006, 40 patients with a symptomatic full-thickness rotator cuff tear (supraspinatus tendon tear with or without a tear of the infraspinatus tendon) underwent arthroscopic RCR with either an SR repair with a modified Mason-Allen suture–grasping technique (n = 20) or a DR repair with a suture bridge fixation technique (n = 20). All patients were enrolled in a long-term clinical evaluation, with the Constant score (CS) as the primary outcome measure. Furthermore, an ultrasound examination was performed to assess tendon integrity and conventional radiographs to evaluate secondary glenohumeral osteoarthritis. Results: A total of 27 patients, of whom 16 were treated with an SR repair and 11 with a DR repair, were followed up after a mean ± SD period of 12 ± 1 years (range, 11-14 years). Five patients underwent revision surgery on the affected shoulder during follow-up period, which led to 22 patients being included. The overall CS remained stable at final follow-up when compared with short-term follow-up (81 ± 8 vs 83 ± 19 points; P = .600). An increasing number of full-thickness retears were found: 6 of 22 (27%) at 2 years and 9 of 20 (45%) at 12 years after surgery. While repair failure negatively affected clinical results as shown by the CS (P < .05), no significant difference was found between the fixation techniques (P = .456). In general, progressive osteoarthritic changes were observed, with tendon integrity as a key determinant. Conclusion: Arthroscopic RCR with either an SR or a DR fixation technique provided good clinical long-term results. Repair failure was high, with negative effects on clinical results and the progression of secondary glenohumeral osteoarthritis. While DR repair slightly enhanced tendon integrity at long-term follow-up, no clinical superiority to SR repair was found.

… for repairable tears of the rotator cuff that have no evidence of rotator cuff arthropathy. There … of arthroscopic rotator cuff repair. Our goal is to describe the evolution of arthroscopic …

… An ultrasound examination was also done at the final follow-up visit to assess the integrity of the rotator cuff repair (Fig. 1). An independent examiner with extensive experience with …

… follow-up of arthroscopic rotator cuff repair was evaluated in 48 consecutive arthroscopic repairs of medium to large rotator cuff … This study has shown that arthroscopic rotator cuff repair …

… current study prospectively evaluated a series of rotator cuff repairs to look for … the evaluation of preoperative and postoperative tendon state and muscular atrophy by using MR imaging. …

… Magnetic resonance imaging (MRI) and ultrasound (US) are both used in evaluating pathology after rotator cuff repair… both expected postoperative and abnormal findings on MRI, while …

… This manuscript is a review of some of the most common treatment strategies for rotator cuff pathology, with a focus on expected postoperative imaging findings and postoperative …

Background: It is unclear which is the most useful imaging tool to diagnose rotator cuff retears. Objective: The objective of this study was to evaluate MRI and ultrasound (US) in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review/meta-analysis. Evidence Acquisition: A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed diagnostic accuracy of MRI and US (index tests) for diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. Evidence Synthesis: Eight studies (six MRI, two US) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, 221; US, 83) and 309 shoulders (MRI, 226; US, 83). Years of publication ranged from 1993 to 2006 for MRI studies and from 2003 to 2018 for US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6¬-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p= .28-.76). Conclusion: Our analyses revealed no significant difference between US and MRI for diagnosis of rotator cuff tendon tears after prior cuff repair. Clinical Impact: Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.

… underwent rotator cuff repair and reporting post-operative MR assessment of the rotator cuff … No restrictions on surgical technique were applied; therefore, studies reporting MR imaging …

… Because not all post-operative imaging findings result in disability or pain for the patient, we … how best to define imaging abnormalities after rotator cuff surgery. IMAGING APPROACH …

… The MRI scans were conducted … images were taken after resection with or without rotator cuff reconstruction … Sakkers et all* suggest that the value of postoperative MRI is limited by …

… We evaluated postoperative tendon healing using MRI and ultrasound … agreement between ultrasound and MRI evaluations of rotator cuff repair. These findings will be important when …

… of repaired rotator cuff tears at more than 1 time postoperatively… -term survival probability of rotator cuff repairs with follow-up … time for an assessment of the rotator cuff integrity can be …

… Our findings are relevant for the postoperative assessment of the symptomatic RC in that they emphasize that correlation of clinical results with imaging findings is essential to ensure …

… tears at our institution, availability of preoperative and 5- to 6-month postoperative magnetic resonance imaging (MRI) findings, and a follow-up duration of more than 1 year. A total of …

… Other studies of the postoperative rotator cuff have shown that … postoperative MRI appearance of the rotator cuff over the first year after surgery and attempts to correlate the MRI findings …

… The primary objective of this study is to use imaging modalities to evaluate the … repair of rotator cuff tears. This study is designed to evaluate the maintenance of integrity of the repaired …

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and …

Importance Recurrent tear after rotator cuff repair (RCR) is common. Conservative, and open and arthroscopic revisions, have been advocated to treat these failures. Aim or objective The purpose of this systematic review was to evaluate the different options for managing recurrent rotator cuff tears. Evidence review A search was conducted of level I through 4 studies from January 2000 to October 2015, to identify studies reporting on failed RCR. 10 articles were identified. The overall quality of evidence was very low. Findings Mid-term to long-term follow-up of patients treated conservatively revealed acceptable results; a persistent defect is a well-tolerated condition that only occasionally requires subsequent surgery. Conservative treatment might be indicated in most patients, particularly in case of posterosuperior involvement and poor preoperative range of motion. Revision surgery might be indicated in a young patient with a repairable lesion, a 3 tendon tear, and in those with involvement of the subscapularis. Conclusions and relevance The current review indicates that arthroscopic revision RCR can lead to improvement in functional outcome despite a high retear rate. Further studies are needed to develop specific rehabilitation in the case of primary rotator cuff failure, to better understand the place of each treatment option, and, in case of repair, to optimise tendon healing.

… All patients got preoperative, 6-week postoperative, 3-month postoperative, and 1-year postoperative MRIs to closely evaluate healing and to also determine timing of any failures. …