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Rotator cuff repair

Surgeon-side topic for rotator cuff repair. Backed by 410 articles from the corpus, retrieved via combined MeSH + title-text matching.

224 citationsUpdated Oct 2026

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Overview

Arthroscopic rotator cuff repair has evolved into one of the most common orthopedic surgical procedures worldwide [22]. The primary indication for revision surgery is the persistence of clinical symptoms despite nonsurgical management in the absence of substantial risk factors for failure [2, 4]. While patient characteristics and indications were not described in a majority of clinical outcome studies [1], repeat cuff repair can improve pain and function when indicated [72]. Outcomes of repeat procedures are poorer than primary repairs if criteria such as small retear, good tissue quality, and no osteoarthritis are not met [72]. Open rotator cuff repair remains a valid option in specific indications and in settings where arthroscopic resources are limited [58]. There is no evidence of difference in effectiveness between open and arthroscopic repair of rotator cuff tears [212].

Short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to those after primary rotator cuff repair [5, 7]. Prevention of complications and successful primary rotator cuff repair results in better functional outcomes despite the availability of revision strategies and treatment options [6]. At long-term follow-up (≥15 years), patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function [18]. These patient-reported outcomes remain durable over a period of 15 years [18]. Rotator cuff repair is cost-effective for all populations [201]. Outpatient rotator cuff repair can be a safe and successful procedure when performed in appropriately selected patients [211].

There is still work to be carried out to improve healing rates, outcomes, and long-term durability of arthroscopic rotator cuff repair [22]. It was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair due to low methodological quality of included studies [19]. There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol [23]. A paucity of rigorous clinical evaluation for both effectiveness and safety prevents firm recommendations for augmented rotator cuff repair with implantable meshes [74]. Retrospective and prospective evaluations of the outcome of rotator cuff repair are different [75]. Critical Shoulder Angle and Acromial Index do not appear to influence 24-month functional outcomes postoperatively [76]. These indices are not contraindications to arthroscopic rotator cuff repair [76]. Shoulder surgeons must carefully interpret literature comparing open and arthroscopic rotator cuff repair outcomes, as differences in complications may be influenced by selection bias and narrowing indications for open repair [64]. One-year follow-up is not the last word for rotator cuff repair outcomes [71]. Authors are obliged to evaluate long-term outcomes of rotator cuff repair procedures [71]. The widely accepted 2-year benchmark for rotator cuff repair outcomes may be arbitrary and does not add clinical relevance [194]. One-year follow-up appears clinically sufficient for rotator cuff repair outcomes [194].

Anatomy & Pathophysiology

Anatomy

The rotator cuff is a sheet of conjoined tendons closely applied over the shoulder capsule, inserting mainly into the greater tuberosity of the humerus, with the subscapularis inserting into the lesser tuberosity [9]. The cuff consists of the subscapularis anteriorly, supraspinatus superiorly, and infraspinatus and teres minor posteriorly [9]. It stabilizes the humeral head by pulling it firmly into the glenoid whenever the deltoid lifts the arm forwards or sideways [9]. The coracoacromial arch is a fibro-osseous canopy formed by the acromion process posterosuperiorly, the coracoid process anteriorly, and the coracoacromial ligament joining them [9]. The subacromial bursa separates the rotator cuff tendons from the coracoacromial arch, allowing them to glide [9].

Muscle Origins and Insertions: * Subscapularis: Arises from the anterior aspect of the scapula and attaches over much of the lesser tuberosity [91]. * Supraspinatus: Arises from the fossa superior to the scapular spine, passes beneath the acromion and acromioclavicular joint, and attaches to the superior aspect of the greater tuberosity [91]. * Infraspinatus: Arises from the fossa below the scapular spine and attaches to the posterolateral aspect of the greater tuberosity [91]. * Teres Minor: Arises from the lower lateral aspect of the scapula and attaches to the lower portion of the greater tuberosity [91].

Innervation: * Supraspinatus: Innervated by the suprascapular nerve after it passes through the suprascapular notch [91]. * Infraspinatus: Innervated by the suprascapular nerve after it passes through the spinoglenoid notch [91]. * Teres Minor: Innervated by a branch of the axillary nerve [91]. * Subscapularis: Innervated by the upper and lower subscapular nerves [91].

Histologic studies describe the rotator cuff tendons as having five distinct layers [91]. The most superficial layer consists of coracohumeral ligament fibers oriented obliquely to the muscle axis [91]. The second layer is composed of large bundles of fibers extending from the supraspinatus tendon over the biceps tendon groove [91]. The third layer contains smaller, less tightly packed tendon fascicles with less uniform orientation [91]. The fourth layer is composed of loose connective tissue with thick bands of collagen fibers that merge with the coracohumeral ligament at the anterior edge of the supraspinatus [91]. The fifth and deepest layer is a continued sheet of collagen fibrils composing the superior joint capsule [91]. There is significant interdigitation and overlap of the supraspinatus and infraspinatus tendons near the footprint [91]. The infraspinatus insertion occupies the preponderance of the footprint on the greater tuberosity [91].

The supraspinatus footprint measures 13 mm width medial-lateral and 20 mm anteroposterior [26]. The infraspinatus footprint measures 14 mm wide and 20 mm superoinferior [26]. A 7 mm medial-lateral tear corresponds to a 50% partial thickness tear of the supraspinatus [26]. The rotator cable is a thick bundle of fibers running perpendicular to the supraspinatus tendon fibers, connecting the supraspinatus and infraspinatus tendons [26]. The rotator cable is divided into anterior, middle, and posterior segments [94]. The anterior segment forms the lateral part of the rotator interval [94]. The middle segment runs under the supraspinatus tendon perpendicular to its longitudinal axis [94]. The posterior segment is covered by the infraspinatus tendon and ends at the insertion region between the infraspinatus and teres minor tendons [94].

The long head of the biceps tendon attaches to the supraglenoid tubercle, runs between the subscapularis and supraspinatus, and exits through the bicipital groove under the transverse humeral ligament [91]. The coracohumeral ligament and transverse humeral ligament keep the long head of the biceps tendon aligned in the groove [91]. The long head of the biceps tendon may serve as a passive restraint during shoulder motions and contribute to anterior stability in abduction and external rotation [91]. The hypovascular critical zone is located on the articular side of the rotator cuff close to the insertion on the greater tuberosity [26].

Pathophysiology

Rotator cuff tears represent a spectrum of disease starting with tendinitis (20–35 years), progressing to tendinosis (35–45 years), rotator cuff tears (>45 years), and cuff arthropathy (>65 years) [26]. The prevalence of rotator cuff tears is 28% in patients under 50 years and 65% in patients over 70 years [26]. The prevalence of full-thickness rotator cuff tears is approximately 25% in patients over 60 years and increases to 50% in patients over 80 years [17]. The overall prevalence of asymptomatic partial-thickness rotator cuff tears is 20%, increasing to 26% in patients older than 60 years [3]. Partial-thickness rotator cuff tears have a limited ability to spontaneously heal [3]. As many as 53% of partial-thickness rotator cuff tears will progress in tear size [3]. A portion of partial-thickness rotator cuff tears will progress to full-thickness rotator cuff tears [3].

Risk Factors: * Age * Smoking * Female sex * Family history * Diabetes * High cholesterol [26]

Intrinsic degeneration involves age-related changes in collagen, proteoglycan, water content, and vascularity (tendinosis), usually involving the supraspinatus and infraspinatus starting on the articular side [26]. Extrinsic injury mechanisms involve chronic impingement on the coracoacromial arch, with tears usually starting on the bursal side of the tendon [26]. Acute traumatic tears typically occur after a fall and/or dislocation of the shoulder in patients under 40 years [26]. Biopsy specimens of retrieved tendon from rotator cuff tears show disorganized collagen, scar tissue, and minimal attempts at a healing process [10]. The confluence of age-related tendinosis and apoptosis leads to tendon failure [10]. Apoptosis is an organized form of cell death involving a programmed sequence of events leading to cellular elimination [10].

Impingement Factors: * Intrinsic: Tendon degeneration, changes in highly sulphated glycosaminoglycans, changes in collagen composition with loading, and changes in vascularity [114]. * Extrinsic: Spurs growing down the coracoacromial ligament and osteoarthritic thickening of the acromioclavicular joint [114].

The "impingement position" is defined as abduction, slight flexion, and internal rotation [114]. The critical shoulder angle is formed by lines drawn from the inferior glenoid to the superior glenoid and from the inferior glenoid to the inferolateral acromion [238]. A critical shoulder angle above 35° to 38° has been shown to correlate with rotator cuff tears and postoperative retears [238]. A critical shoulder angle less than 30° has been shown to correlate with osteoarthritis [238]. The acromial index is the ratio of the medial/lateral length from the glenoid to the lateral acromion divided by the length from the glenoid to the lateral aspect of the greater tuberosity [238]. An acromial index above 0.7 has been associated with full-thickness rotator cuff tears and higher retear rates [238]. Increased lateralization of the acromion and increased superior glenoid inclination may increase the shear forces of deltoid contraction [238].

Rotator cuff disease may involve a genetic predisposition to intrinsic degenerative tendinopathic changes in molecular composition and vascularity [238]. Studies have shown familial hereditary patterns of rotator cuff disease and genes associated with significant pathology [238]. The articular side of the rotator cuff is less vascular than the bursal surface [116]. The articular side of the rotator cuff has a higher modulus of elasticity, greater stiffness, and a less favorable stress-strain curve compared with the bursal surface [116]. Eccentric forces tend to be concentrated more along the articular surface fibers [116]. Shear stress created between tangential and perpendicularly directed forces within the five-layered architecture of the rotator cuff tendon may contribute to intratendinous tear location [116].

Muscle degeneration following rotator cuff injury is largely mediated by fibroadipogenic progenitor cells (FAPs) [294]. In the chronic setting, remaining FAPs differentiate into adipocytes and fibroblasts, leading to fatty infiltration and intramuscular fibrosis [294]. Fatty infiltration and intramuscular fibrosis are known risk factors for rotator cuff retear after arthroscopic repair [294]. The progression of rotator cuff disease from tendinitis to degenerated full-thickness tear is a failure of biology [243]. In chronic tears, tissue is unable to respond productively to injury, resulting in deposition of disorganized connective, fatty, and fibrous tissue [243].

A normal tendon-bone insertion site is not regenerated after tendon-to-bone repair [296]. Rotator cuff healing occurs by reactive scar formation rather than regeneration of a histologically normal insertion site [296]. The zone of calcified cartilage does not re-form after rotator cuff repair [296]. Poor healing response likely relates to incomplete and abnormal expression of genes that direct formation of the complex structure and composition of the insertion site [296]. Insufficient numbers of undifferentiated cells at the healing interface contribute to poor rotator cuff healing [296]. Mechanical load on the healing tendon (tendon-bone interface motion) contributes to poor rotator cuff healing [296]. Inflammation in the postnatal organism is a fundamental reason for the lack of appropriate molecular signals and cell differentiation during rotator cuff healing [296]. Tendon repair results in the formation of fibrovascular scar that never attains the gross, histological, or mechanical characteristics of normal tendon [261]. Tendon has very little regenerative capacity of its own [261].

The rotator cuff tendons are intra-articular and thus intrasynovial [69]. The native fibrocartilaginous insertion to the greater tuberosity is not reconstituted after repair [69]. Chronic tendinopathy leads to impaired biological healing capacity on both the tendon and bone side [69]. Factors associated with failure of rotator cuff repair include muscle degeneration (fatty infiltration and atrophy), tear size, chronicity, advanced age, and other environmental factors [69]. Glenohumeral decentering is significantly associated with diminished shoulder function and active range of motion in all planes [122]. Increased glenohumeral joint loads due to a full-thickness supraspinatus tear can be reversed with rotator cuff repair [138]. Isolated supraspinatus tears did not perturb glenohumeral kinematics in a cadaveric model of the throwing shoulder [140]. Shoulder posture is an important determinant of passive forces during rotator cuff repair surgery [142]. The glenohumeral joint contact center gradually shifts superiorly after rotator cuff repair, potentially reflecting altered loading patterns or loss of dynamic stability [147]. Dynamic elongation of repair tissue during scapular-plane abduction exhibits distinct patterns suggesting different patterns of supraspinatus mechanical and neuromuscular function [137].

Three-dimensional shoulder kinematics normalize after rotator cuff repair [89]. Observed changes in scapular kinematics after rotator cuff repair are associated with increased overall range of motion and suggest restored function of shoulder muscles [89]. More significant increases in shoulder kinematics are observed at the 6-month evaluation than at the 3-month evaluation after rotator cuff repair [192]. Participants with rotator cuff repair accomplish activities of daily living through thoracohumeral joint kinematics similar to those in healthy shoulders [204]. Most shoulders with early motion loss after rotator cuff repair recover motion and rarely require capsular release [205].

Classification

Partial-Thickness Tears

Partial-thickness rotator cuff tears are classified as articular-sided, bursal-sided, or intratendinous [3]. The Ellman classification grades these tears based on location and depth noted during shoulder arthroscopy [3]. Grade 1 tears involve 3 mm or less of tendon thickness, grade 2 tears involve 3 to 6 mm, and grade 3 tears involve more than 6 mm [3]. Grade 3 tears represent tears of more than 50% of tendon width [3]. MRI evaluation classifies partial-thickness tears as low grade or high grade depending on whether they involve less than or more than 50% of the tendon width [3]. Delamination-type tears of the articular side are commonly found in athletes involved in throwing and in sports requiring overhead motion [3].

Full-Thickness and Massive Tears

The Cofield classification categorizes rotator cuff tears as small (0–1 cm), medium (1–3 cm), or large (3–5 cm) [51]. The Snyder classification describes the extent, location, and size of rotator cuff tears [270]. Tear location is classified as articular (type A), bursal (type B), and complete (type C) [270]. Type 1 full-thickness tears are defined as small tears [270]. Type 2 tears are moderate tears less than 2 cm of only 1 tendon without retraction [270]. Type 3 tears are large complete tears, usually 3 to 4 cm, with minimal retraction [270]. Type 4 tears are massive rotator cuff tears involving 2 or more rotator cuff tendons with associated retraction [270].

The Hamada classification uses a mechanistic approach to explain radiographic changes seen with chronic massive rotator cuff tears [164]. It highlights the progressive nature of massive rotator cuff tears leading to CTA [164]. A radiographic classification of massive rotator cuff tear arthritis exists to confirm the temporal evolution of grades [174]. Patients with Grade 3–5 massive rotator cuff tears at initial examination were on average older than those with Grade 1 or 2 tears [174].

Repair Integrity and Healing

The Sugaya classification distinguishes 5 repair categories using oblique coronal, oblique sagittal, and transverse T2-weighted images [274]. Type 1 indicates a repaired rotator cuff with sufficient thickness and homogeneously low intensity on each image [274]. Type 2 indicates sufficient thickness with a partial high-intensity area [274]. Type 3 indicates insufficient thickness without discontinuity [274]. Type 4 indicates a minor discontinuity in more than 1 slice of each image, suggestive of a small tear [274]. Type 5 indicates a major discontinuity on each image, suggestive of a large tear [274].

The modified Patte classification system has excellent diagnostic performance for reparability and acceptable performance for rotator cuff healing [154]. It also demonstrates high measurement reliability [154]. A grading system using computed tomography arthrography classifies structural integrity as intact, incomplete leakage, or complete leakage [266]. In the Boileau et al. grading system, 'intact' integrity indicates no leakage at the insertion or in the tendon [266]. 'Incomplete leakage' indicates a small slit of contrast medium leakage into the tendon limited to one oblique coronal section [266]. 'Complete leakage' indicates apparent discontinuity with contrast medium into the subacromial space [266]. Healing is defined as occurring when structural integrity is both intact at the insertion and in the tendon [266]. Incomplete healing is defined when the integrity is incomplete leakage either at the insertion or in the tendon [266]. Retears are defined if complete leakage is present at the insertion [266]. New tears are defined if complete leakage is present in the tendon [266].

Other Classifications

The Samilson and Prieto classification is used to grade the degree of osteoarthritis in the shoulder [279]. The Bigliani-Morrison classification is used to assess acromial type [270].

Clinical Presentation

Symptoms and History

Patients with symptomatic full-thickness rotator cuff tears typically report anterolateral shoulder pain radiating into the subdeltoid location [17]. Common complaints include pain with overhead activity and lifting objects with an outstretched arm [17]. Frequent night pain and sleep disturbance are also characteristic features [17]. In chronic rotator cuff disease, patients often describe an insidious onset of lateral and/or anterior shoulder pain associated with overhead activities [213]. Night pain remains a common presenting symptom in these chronic cases [213]. A clear history of trauma resulting in acute pain and weakness strongly suggests an acute rotator cuff tear [213]. Additionally, a family or personal history of rotator cuff disease increases the likelihood of diagnosis [213].

In pediatric populations, pain was the most common presenting complaint, reported in 21 out of 23 patients with available initial presentation data [96]. Other pediatric presenting complaints included weakness (n=6), functional impairment (n=3), decreased range of motion (n=2), dislocation (n=2), and numbness (n=2) [96]. The time from injury to diagnosis in pediatric cases ranged from 1 day to 24 months [96]. Forty-five pediatric patients were diagnosed within 6 months of injury, with 11 diagnosed within 1 month [96]. Five pediatric patients were diagnosed at least one year after injury [96]. The combination of age >65 years, night pain, and weakness has 95% specificity for rotator cuff tears [26]. Symptoms of depression and anxiety related to the shoulder improved dramatically after rotator cuff repair, regardless of a preexisting clinical diagnosis of depression or anxiety [102].

Physical Examination

Physical examination is critical in the workup of rotator cuff tears and consists of assessment of range of motion in adducted and abducted positions, assessment of strength, and examination of associated structures such as the biceps and acromioclavicular joint [213]. Inspection for muscular atrophy of the deltoid and supraspinatus and infraspinatus fossa is part of the physical examination for chronic rotator cuff tears [26]. Palpation of the greater tuberosity, acromioclavicular joint, bicipital groove, and coracoid process is also performed [26]. Cervical spine palpation, range of motion, and Spurling test are conducted to rule out cervical spine pathologies as a cause of shoulder pain [26].

Resisted elevation tests such as Jobe, empty can, and drop arm sign assess supraspinatus function [26]. The empty can test has a sensitivity of 71.7% and a specificity of 64.6% for full-thickness supraspinatus tears [213]. External rotation tests such as lag sign, Patte, and hornblower sign assess infraspinatus/teres minor function [26]. Patients with an external rotation lag sign at the side likely have a large posterosuperior tear involving the infraspinatus [213]. A positive hornblower sign suggests a massive posterosuperior cuff tear that prohibits the active positioning of the hand in space [213]. A positive lag sign indicates a massive rotator cuff tear [26]. Internal rotation tests such as belly press, lift-off (Gerber), modified lift-off, and bear hug assess subscapularis function [26]. The lift-off and belly-press tests have high specificity but low sensitivity for full-thickness subscapularis tears [213]. Deltoid strength and axillary nerve function are assessed during the physical examination [26].

In pediatric rotator cuff tears, special tests for specific rotator cuff muscle function were reported in 17 total patients [96]. Sixteen of 17 pediatric patients had at least one positive special test that indicated rotator cuff pathology [96]. In two pediatric patients, testing was limited due to pain [96]. Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing [131]. However, teres minor hypertrophy is not a positive predictor of outcomes following rotator cuff repair [131].

Imaging and Diagnostic Studies

MRI is the benchmark for diagnosing rotator cuff tears with 94% sensitivity and 93% specificity [26]. T2-weighted images best visualize rotator cuff tears [26]. T1 sagittal oblique cuts reveal muscle/tendon retraction and muscle atrophy to determine chronicity, reparability, and outcome of surgical rotator cuff repairs [26]. Intra-articular contrast-enhanced magnetic resonance arthrography (MRA) is best for detecting partial-thickness rotator cuff tears with 95% sensitivity and 95% specificity [26]. MRI accurately assesses muscle, bone, and cartilage, which has advantages for surgical planning [213].

Ultrasonography has good accuracy with 92% sensitivity and 93% specificity for rotator cuff tears [26]. For full-thickness rotator cuff tears, ultrasonography approaches the sensitivity and specificity of MRI for detecting the presence of a tear with an experienced practitioner [213]. Ultrasonography allows for dynamic assessment of the cuff insertion [26]. However, ultrasonography is operator dependent and has limited assessment of chondral lesions [26]. It also has poor sensitivity to diagnose partial-thickness rotator cuff tears [26].

Radiographs are used to rule out glenohumeral and acromioclavicular arthritis [26]. The true AP view evaluates the acromiohumeral interval, critical shoulder angle, and acromion index [26]. Greater tuberosity excrescences on AP views in external and internal rotation are pathognomonic for cuff disease [26]. The supraspinatus outlet view evaluates acromial morphology according to Bigliani classification [26]. The axillary view assesses glenohumeral joint morphology and joint space and rules out dislocations [26]. CT arthrography is uncommon in the United States but useful in postoperative assessment, retear evaluation in patients with retained metallic anchors causing artifact on MRI, and when MRI is contraindicated [26].

The goal of diagnostic imaging is to determine the presence, size, and orientation of the rotator cuff tear; evaluate the healing capacity of the tendon; and assess associated pathology such as long head biceps tendinitis, acromioclavicular joint pathology, and arthrosis [213]. Diagnosis of a rotator cuff tear requires a full clinical examination combined with imaging studies including ultrasound, arthrocomputed tomography, and magnetic resonance imaging/arthroemagnetic resonance imaging [88].

In pediatric rotator cuff tears, radiograph results were reported for 17 patients, of which 12 were negative and 5 showed signs of pathology [96]. Of the 5 pediatric patients with positive radiographs, only 2 were specific to the rotator cuff [96]. In one pediatric patient, an arthrogram demonstrated signs of partial rotator cuff tendon tear [96]. In another pediatric patient, a halo of calcification superior to the humeral head in the subacromial space indicated long-standing supraspinatus injury [96]. MRI or magnetic resonance arthrogram results were reported for 51 pediatric patients, of which 50 demonstrated some indication of rotator cuff pathology and only 1 was negative [96]. Ultrasound examinations were reported in 3 studies comprising 3 total pediatric patients, all of which were positive for signs of rotator cuff damage [96].

Classification and Prognostic Factors

Partial-thickness rotator cuff tears are classified as articular-sided, bursal-sided, or intratendinous tears [3]. The Ellman classification grades partial-thickness tears as grade 1 if involving 3 mm or less, grade 2 if 3 to 6 mm, and grade 3 if more than 6 mm of tendon is torn [3]. MRI evaluation classifies partial-thickness tears as low grade or high grade depending on whether they involve less than or more than 50% of the tendon width [3].

The Patte classification divides rotator cuff tears into Group I (partial or full-substance <1 cm), Group II (full-substance supraspinatus), Group III (full-substance >1 tendon), and Group IV (massive tears with secondary OA) [15]. Group I lesions rarely exhibit an operative indication, and physiotherapy aiming to eliminate subacromial impingement usually results in satisfactory pain relief [15]. Group III defects are serious and demand early surgical treatment [15]. Group IV lesions often limit the possibility of repair, and arthroplasty becomes necessary [15].

The Goutallier-Fuchs classification for fatty atrophy uses T1 sagittal MRI cuts: Grade 0 (normal muscle), Grade 1 (some fat streaks), Grade 2 (more muscle than fat), Grade 3 (fat evident on equivalent amount as muscle), Grade 4 (more fat than muscle) [26]. Goutallier grades 3 and 4 are indications of a long-term chronic rotator cuff tear, which has a higher potential for failure when surgery is undertaken and likely is deemed irreparable [17]. The tangent sign corresponds with muscle atrophy and chronicity [26].

Factors associated with failure after rotator cuff repair include larger tears, greater retraction, advanced Goutallier grade, older age, smoking status, osteoporosis, diabetes mellitus, hypercholesterolemia, and more aggressive rehabilitation protocols [17]. The best potential for healing was in patients younger than 70 years with acute, small tears (<3 cm) and a healthy tendon-bone interface who are compliant with sling wear and are able to undergo an extended rehabilitation program of 6 to 9 months [17]. Carefully selected patients older than 70 years did well after rotator cuff repair and functionally improved as much as younger patients [17]. Goutallier stages III and IV tears, if accompanied by a tendinous stump of less than 15 mm and a positive tangent sign, have a 90% failure rate [17]. Tears with Goutallier grades III and IV usually are deemed irreparable and are treated with alternative strategies such as debridement, tendon transfer, superior capsular reconstruction, or reverse shoulder arthroplasty [17].

Patient age, expectations, and the extent of the rotator cuff tear influence outcomes following rotator cuff repair [121]. Greater preoperative rotator cuff disease severity was associated with failure to achieve clinically significant outcomes at mid-term follow-up [125]. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates in patients under 50 years [127]. Individual scapular morphology may influence both disease development and surgical outcomes of rotator cuff tears [53]. Patients with a critical shoulder angle greater than 38° and acromial index greater than 0.7 had higher retear rates but similar functional rates compared to control patients [12]. Critical shoulder angle and acromial index do not influence 24-month functional outcome after arthroscopic rotator cuff repair [12]. Tear size, general health status, and smoking influence functional outcome at 5 years following arthroscopic rotator cuff repair [36]. Several patient-specific factors influencing functional and radiologic outcome after rotator cuff repair have been identified [37]. Severely obese patients achieve overall excellent outcomes after repair and noninferior clinical differences when compared to healthy weight patients [50].

Investigations

Plain radiography: Radiographs are the first imaging study obtained for rotator cuff evaluation [215]. They may demonstrate classic changes within the acromion or coracoacromial ligament, including spurring and calcification, as well as cystic changes within the greater tuberosity [157]. With chronic rotator cuff disease, superior migration of the humeral head with extensive degenerative change may be present [157]. The tangent sign is defined as failure of the supraspinatus muscle belly to cross a line from the superior border of the coracoid to the superior border of the scapular spine [157]. This sign correlates with muscle atrophy and fatty infiltration of the supraspinatus [157]. Patients with the tangent sign are more likely to have an irreparable rotator cuff tear [157], and a positive tangent sign predicts the repairability of rotator cuff tears [12]. Irreparable tears are more likely to occur when the acromiohumeral distance appears shorter than 7 mm on AP radiograph [157]. The critical shoulder angle (CSA) is a static radiographic measure that does not change over time [12]. Patients with a CSA greater than 38° and an acromial index (AI) greater than 0.7 had higher retear rates after arthroscopic rotator cuff repair [12]. CSA was higher in patients with rotator cuff tears compared to those without, but differences are small and depend on excellent radiographic technique [12]. CSA and AI do not influence 24-month functional outcome after arthroscopic rotator cuff repair [12].

MRI: Magnetic resonance imaging (MRI) provides the best overall evaluation of the rotator cuff [215]. It is used to define the extent of the tear, degree of tear retraction, and presence of muscular atrophy [157]. MRI is key for evaluating fatty infiltration, although the Goutallier classification was originally based on CT [157]. MRI and magnetic resonance arthrography (MRA) are both sensitive and specific for full-thickness rotator cuff tears [163]. The sensitivity of MRI for detecting full-thickness rotator cuff tears is 92.1% [163], with a specificity of 92.9% [163]. The sensitivity of MRA for detecting full-thickness rotator cuff tears is 95.4% [163], with a specificity of 98.9% [163]. For partial-thickness tears, the sensitivity of MRI is 63.6% [163] and specificity is 91.7% [163]. The sensitivity of MRA for detecting partial-thickness rotator cuff tears is 85.9% [163], with a specificity of 96.0% [163]. MRA is more sensitive for the detection of partial-thickness, particularly articular-sided tears [163]. A full-thickness rotator cuff tear is identified if fiber discontinuity spans the entire thickness of the tendon, with the defect filled with fluid signal intensity on T2-weighted sequences or with gadolinium on T1-weighted sequences of an MRA [163]. The description of a full-thickness tear should include the tendon(s) involved, location within the tendon, AP dimension, and extent of retraction [163]. The AP dimension of a full-thickness tear is best measured on the sagittal view [163]. The extent of retraction for supraspinatus and infraspinatus tears is best measured on the coronal sequence [163], while the extent of retraction for subscapularis tears is best measured on the axial sequence [163]. A partial-thickness rotator cuff tear spans only a portion of the tendon thickness [163]. The description of a partial-thickness tear should include the tendon(s) involved, location within the tendon, percentage of tendon thickness affected, and the side of the tendon torn [163]. Articular-side thickening of the supraspinatus and infraspinatus on images obtained in the neutral position suggests the presence of a partial-thickness articular-side rotator cuff tear [163]. The rotator cable can be reliably identified with the shoulder in ABER position, even in the absence of a rotator cuff tear [163]. MRI often fails to diagnose the presence of subscapularis tears and infraspinatus tears, while concordance with MRI results is good for the supraspinatus [84]. MRA is not suitable for the diagnosis of long head of biceps (LHB) lesions prior to arthroscopic rotator cuff repair [344], and magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair [291].

Ultrasonography: Ultrasonography is increasing in popularity as a tool for the diagnosis of rotator cuff disease [157]. It is also used for confirmation of intraarticular or subacromial location of injections [157]. Ultrasonography is more accurate for full-thickness rotator cuff tears, comparable to MRI [12].

Postoperative Imaging: Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome after arthroscopic transosseous rotator cuff repair [33]. Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair [80]. Most deformities after rotator cuff repair remodel over time and do not affect the radiologic outcome of repair after 6 months of follow-up [314]. Ultrasonography is an adequate imaging modality to classify rotator cuff repair integrity, reducing economic and practical burdens of CT, MRI, or MRA [322]. In the community setting, ultrasound may be used to evaluate the integrity of a repaired rotator cuff tendon and constitutes a comparable alternative to MRI [332]. Poor interobserver agreement regarding postoperative graft and rotator cuff integrity by MRI was found in superior capsular reconstruction augmentation studies [320]. After successful arthroscopic rotator cuff repair, there was a slight increase in supraspinatus muscle volume from preoperatively to final follow-up, as seen on serial MRI [269]. A prospective pilot study suggests a temporal relationship of MRI and ultrasound parameters that parallels the expected phases of healing in the repaired rotator cuff [273]. In 18 of 22 patients (82%) with partial-thickness rotator cuff tears treated with tear completion followed by surgical repair, there was no evidence of a full-thickness or near full-thickness defect on follow-up MRI at a minimum of 2 years [246]. On magnetic resonance imaging scans, seven rotator cuff repair failures (15.9%) were observed in patients treated with arthroscopic augmented rotator cuff repairs using extracellular porcine matrix patch [263]. Tear size was identified as an independent predictor of re-rupture at one-year follow-up in patients treated with arthroscopic augmented rotator cuff repairs using extracellular porcine matrix patch [263]. Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI [345]. The shift angle and medial retraction of the deep layer on magnetic resonance imaging are associated with intraoperative reparability in large-to-massive rotator cuff tears [342]. Arthroscopic rotator cuff repair could be indicated regardless of the appearance of the greater tuberosity if MRI showed lesser degrees of fatty degeneration [343]. There is no MRI difference in 12-month rotator cuff retear rates between triple-loaded single-row repairs or suture-bridging double-row repairs [330]. Although MRI data suggest improved healing rates in single-row repairs in the entire patient population, double-row repair showed improved radiographic healing when similar-sized tears were compared [297]. Double-row rotator cuff repair has been shown to have improved tendon-bone healing rates on postoperative imaging, but it is unclear whether this translates to improved clinical outcomes [281]. Rotator cuff repairs augmented with a porcine dermal patch resulted in excellent clinical outcomes with a higher healing rate and close-to-normal MRI findings [285]. 50% of patients who underwent biologically enhanced demineralized bone matrix augmentation of their rotator cuff repair demonstrated MRI-determined failure of supraspinatus healing [325]. Magnetic resonance imaging is useful for the evaluation of patients who have pain and loss of function after a repair of the rotator cuff, particularly for identifying full-thickness tears, intact cuffs, ruptures of the biceps tendon, and detachments of the origin of the deltoid muscle [327]. MRI is less effective for evaluating partial-thickness tears in the context of failed repairs [327]. No significant differences were found at a mean 3-year follow-up in the retear rates, pain, range of motion, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative corticosteroid injections [341]. After arthroscopic supraspinatus tendon repair, image-guided platelet-rich plasma (PRP) treatment on 2 occasions does not improve early tendon-bone healing or functional recovery [346]. Smoking is associated with a higher risk of imaging-confirmed structural failure after arthroscopic rotator cuff repair [303].

Other Considerations: Metal artefacts from titanium suture anchors prevented accurate diagnosis from MRI scans of rotator cuff retear in 36% of patients studied [333]. Biocomposite suture anchors are frequently still visible on MRI 2 years after rotator cuff reconstruction [85]. Immediate changes in the appearance of fatty infiltration and muscle atrophy on MRI should be considered when comparing preoperative and postoperative images [292]. The MRI appearance of the repaired tendon changes over time but does not correlate with function or predict clinical outcomes at 1 year after surgery [293]. Inter-rater agreement for rotator cuff tendon and muscle MRI parameters indicates a need for improved imaging tools for precise evaluation due to clinically significant disagreements [309].

Treatment

Non-Operative

Non-surgical treatment is the preferred initial approach for patients with non-traumatic rotator cuff injuries [229]. Most partial-thickness rotator cuff tears are best initially managed with nonoperative treatment [3]. Patients who can benefit from a trial of conservative treatment are one of three main categories based on the potential risk of nonoperative treatments and the proposed benefits of surgical intervention [8]. Delay of supraspinatus repair by up to 12 weeks does not impair enthesis formation, supporting a trial of conservative treatment and positive outcomes for delayed repair [206].

Operative

Indications: Clinical decision-making for the management of rotator cuff tears can be complex and lacks consensus among orthopedic surgeons [8]. Neither the clinical practice guidelines set out by the American Academy of Orthopaedic Surgeons nor the Cochrane systematic reviews provide guidance on the management of rotator cuff tears [8]. Surgical repair provides significantly better long-term outcomes and a higher probability of substantial improvement for symptomatic rotator cuff tears compared to nonoperative treatment, which may yield better short-term outcomes [217]. However, there are not convincing data of the superiority of the operative treatment over non-operative management in all rotator cuff tears [156], and rotator cuff repair may not alter natural history [16]. Repair of symptomatic single-tendon rotator cuff tears in patients aged older than 65 years who do not respond to conservative treatment appears justified [241]. Operative management of cuff tears is increasingly cost-effective with time, given nonrepaired cuff tears are unlikely to heal and portend worse symptomatology [188]. Arthroscopic examination and attempted repair of large and massive rotator cuff tears is considered the gold standard of treatment for nonarthritic shoulders [280]. One-stage treatment for rotator cuff tears in stiff shoulders provides comparable range of motion and patient-reported clinical outcomes as rotator cuff repair for non-stiff shoulders [262].

Surgical Approach / Technique: The current standard of care for rotator cuff repair is arthroscopic repair, although the superiority of arthroscopic versus open or mini-open repair is still somewhat controversial [69]. Arthroscopic repair has been shown to have similar outcomes and failure rates compared to open or mini-open repair, with decreased short-term pain and more rapid return to activity [69]. Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited [58]. The goal of rotator cuff repair is to restore the tendon to its anatomic footprint to encourage healing [69]. Controlled laboratory studies have generally shown superiority of double-row techniques over single-row in terms of initial and ultimate failure strength, decreased gap formation, decreased strain and suture cut-through, and improved vascularity in transosseous-equivalent double-row repair [69]. The double-row technique has been advocated as a better biomechanical construct and a more anatomic repair strategy, although superior clinical results with double-row fixation over single-row fixation is still controversial [234]. The healing of the rotator cuff using an anatomic technique was superior to that in the single row repair group [150]. Both double-row knotless and knot-tying anchor techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome [143]. The novel all-inside arthroscopic rotator cuff repair technique was safe and significantly faster and provided better healing rates than other repair techniques [144]. Arthroscopic transosseous rotator cuff repair achieves similar clinical outcomes, patient-reported outcomes, and healing rates with 30-80% reduction in implant costs, compared to traditional anchored techniques [352].

Implant Selection: Shoulder function was improved after complete rotator cuff repair and similar clinical outcomes were achieved regardless of suture anchor material and shape [73]. At a short-term follow-up, differences between arthroscopic repair of full-thickness rotator cuff tears with metal and biodegradable suture anchors were not significant [302]. Every tested knotless suture anchor presented different problems that may lead to premature failure of the rotator cuff reconstruction [337]. Gap formation between the bone and the soft tissue fixation jeopardizes the repair, and an anchor is not appropriate for rotator cuff repair if used on its own if it causes gap formation [319]. Initial fixation strength is an essential consideration in optimizing rotator cuff repair [328]. The ideal rotator cuff repair technique should have high initial fixation strength to allow minimal gap formation between the tendon and bone [347]. A healed rotator cuff repair results in a superior outcome for the patient compared with a non-healed repair [68]. Surgeons can maximize the chance of a healed repair by adhering to core principles regarding tear pattern recognition, repair construct selection, biological healing optimization, and avoiding aggressive early rehabilitation [68].

Partial-Thickness Tears: Partial-thickness rotator cuff tears have a limited ability to spontaneously heal as shown by histological and radiographic studies [3]. As many as 53% of partial-thickness rotator cuff tears will progress in tear size, and a portion of these will progress to full-thickness rotator cuff tears [3]. Surgical treatment with either rotator cuff repair or debridement is indicated for patients in whom nonoperative treatment fails [3]. Tears involving more than 50% of tendon width are best treated with repair and those involving less than 50% with debridement and potential decompression [3]. A higher failure rate of debridement has been suggested for partial-thickness bursal-sided rotator cuff tears compared to articular-sided rotator cuff tears, leading some surgeons to favor repair in even low-grade bursal-sided tears [3]. There is no difference in functional outcome scores or re-tear rates between in situ rotator cuff repair and completion to a full-thickness rotator cuff tear with subsequent repair [3]. For tears with poor-quality tendon remaining and involving more than 80% of tendon thickness, debridement is favored over repair [3]. If delamination of the tear is present in articular-side delamination-type tears, a transtendinous repair is indicated [3]. Intratendinous tears are repaired side-to-side using arthroscopic technique after the tear is opened and the edge debrided back slightly to promote local healing [3]. Extensive debridement is unnecessary for intratendinous rotator cuff tears [3].

Adjuncts: Acromioplasty cannot be recommended as a routine technique in every rotator cuff repair [210]. Despite Clinical Practice Guidelines recommending the nonroutine use of acromioplasty, surgeons continue to perform acromioplasty with rotator cuff repair in most of the cases throughout all subcategorizations analyzed [242]. We do not recommend doing routine distal clavicle resection with arthroscopic rotator cuff repair [62]. Critical shoulder angle and acromial index do not appear to influence 24-month functional outcomes postoperatively and hence are not contraindications to arthroscopic rotator cuff repair [76]. Delamination does not affect outcomes after arthroscopic rotator cuff repair as compared with nondelaminated rotator cuff tears [323]. Both 20° and 45° anchor insertion techniques resulted in acceptable shoulder clinical outcomes for patients with osteoporosis undergoing rotator cuff repair [355]. Solid fixation of the rotator cuff tear was obtained in all cases of rotator cuff repair associated with large greater tuberosity bone cysts [311].

Augmentation and Salvage: The general indications for augmentation include patients with large (>3 cm), multitendon rotator cuff tears or chronic tears with poor tissue quality [198]. Patch augmentation is specifically used to augment posterosuperior rotator cuff tears that are completely reparable and is not recommended to address either completely irreparable or partially reparable tears [310]. Relative indications for arthroscopic rotator cuff repair with patch augmentation include massive rotator cuff tears (i.e., ≥ 2 tendons) with adequate tissue for direct repair and failure of primary repair [300]. Relative contraindications for arthroscopic rotator cuff repair with patch augmentation include irreparable rotator cuff tears and young individuals [300]. A synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective [329]. Magnetic resonance imaging and ultrasound findings for bioinductive collagen scaffolds suggested increased tendon thickness and favorable structural healing, with reported healing rates up to 96% within 12–24 months [79]. Despite the growing clinical use of scaffold devices for rotator cuff repair, numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy remain to be clarified or addressed [195]. Partial rotator cuff repair represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable [60, 61, 153]. For the treatment of large to massive rotator cuff repairs, not all partial repairs are equivalent [39]. Superior capsular reconstruction with incorporation of the native rotator cuff may provide surgeons the opportunity to perform a robust repair in situations where arthroplasty or other more invasive procedures were once the only options [338]. This technique of concomitant superior capsular reconstruction with rotator cuff repair has been a reproducible method for achieving successful surgical management of patients with massive rotator cuff tears and superior capsular insufficiency [152].

Revision: Revision rotator cuff repair is technically more difficult than primary repair due to poor tissue quality, adhesions, and retained hardware [86]. Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair [141]. Every attempt should be made at the time of arthroplasty to balance the soft tissues and securely repair the rotator cuff because subsequent attempts to repair the rotator cuff are prone to failure [40].

Other Considerations: The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair [1]. While concordance with MRI results are good for the supraspinatus, MRI often fails to diagnose the presence of subscapularis tears and infraspinatus tears [84]. Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority [49]. Arthroscopic rotator cuff repair has evolved into one of the most common orthopedic surgical procedures worldwide, yet there is still much work to be carried out to improve healing rates, outcomes, and long-term durability [22]. The prevention of complications and successful primary rotator cuff repair results in better functional outcomes despite the availability of revision strategies and treatment options [6].

Pain Management: Interscalene block is the undisputed gold-standard procedure for postoperative pain management after arthroscopic rotator cuff surgery in patients experiencing considerable pain [276]. It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair [178]. These findings add to the growing body of evidence supporting the use of continuous interscalene block for postoperative analgesia in patients undergoing rotator cuff repair [221]. The combined blocks of arthroscopy-guided suprascapular nerve block and ultrasound-guided interscalene brachial plexus block may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair [225]. Multimodal analgesia for rotator cuff repair should be individualized based on surgical location, complexity, and patient comorbidity [219]. Interscalene block is preferred for complex anterior procedures unless respiratory comorbidities are present, in which case periarticular infiltration combined with pharmacologic therapies is recommended [219]. Following arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills over 6.9 days when used in combination with non-opioid pain medications [237]. Multimodal pain therapy after rotator cuff repair provided at least equivalent pain relief compared to opioid analgesia, and standardized prescription protocols can decrease opioid consumption without reducing patient satisfaction [248]. Multiple factors, including multimodal anesthesia strategies like the ISBPB-plus technique, can reduce opioid requirements after rotator cuff repair, though the optimal strategy has yet to be determined [251]. Pre-incisional intra-articular morphine reduced pain in the first 2 weeks after arthroscopic rotator cuff repair [258]. The study supports the use of gabapentin as an adjunct for pain management in open rotator cuff repair [260]. Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair [267]. Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location [240]. It remains a safe and effective analgesia method during rotator cuff repair surgery [169]. The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects [287].

Postoperative Management and Rehabilitation: Use of higher minimal clinically important difference values should be considered when evaluating improvements of individual patients after rotator cuff repair, to determine comparative effectiveness of various rotator cuff repair techniques and to determine sample sizes for prospective comparative trials [57]. Resilience may be a valuable predictor of patients at risk of having suboptimal outcomes after rotator cuff repair and a target to improve surgical outcomes through non-surgical means [250]. Gender affects early postoperative outcomes of rotator cuff repair, and these findings can serve as guidelines for pain management and rehabilitation after surgery [277].

Complications

General Complication Rates: Rotator cuff repair carries a low incidence of short-term complications [21], which are generally considered rare [44]. However, clinical registries indicate that adverse events may occur in almost 1 of 5 cases [362]. In a literature review of 2,890 patients, 414 complications were associated with arthroscopic rotator cuff repair [134]. A consecutive series of 263 patients undergoing primary arthroscopic repair reported that 28 patients (10.6%) sustained a complication [255]. In a cohort of 2,010 patients, 3% (61/2010) reported a worsened shoulder at 6 months post-repair [111]. Specific subgroups show varying rates: in patients aged 30 years and under, 4 patients (12.5%) underwent reoperations at an average of 8.7 months [264], while in a cohort with diabetes mellitus, 33 patients (8.2%) underwent subsequent reoperation [278]. In a study of 50 patients undergoing reoperation for symptomatic failure, the average number of previous operations was 1.6 [290].

Re-tear and Repair Failure: Re-rupture is the most frequently encountered complication, with rates ranging between 11.4 and 94% in a literature review of arthroscopic repair [134]. Recurrent tears are not uncommon after arthroscopic repair of large and massive tears [25]. Pooled analysis demonstrated a substantial retear rate in both arthroscopic and open/mini-open groups, associated with inferior shoulder function [374]. In a study of 1600 consecutive arthroscopic repairs, a decrease in retear rate occurred during the study period [395]. In a prospective cohort of 1000 consecutive cases of undersurface repair, the retear rate was 1.4%, and 7 patients (0.7%) underwent revision rotator cuff repair [392]. In patients aged 30 years and under, 3 patients (9.4%) had repair failures, including complete re-tears in 2 shoulders and a partial re-tear in 1 shoulder [264]. In a cohort with diabetes mellitus, 20 patients (5.0%) underwent revision arthroscopic surgery for repair failure at a mean 17.6 months, and 7 patients (1.7%) underwent revision to reverse shoulder arthroplasty at a mean 23.7 months [278]. In a study of 50 patients undergoing reoperation for symptomatic failure, persistence of a cuff defect was confirmed by single-contrast arthrography in all cases [290]. Additionally, 28 of 50 patients in that study had started resistive exercises with weights within the first 3 months during rehabilitation [290]. In patients with a rotator cuff repair after a traumatic shoulder dislocation, the incidence of re-interventions was 10%, with the main cause being a symptomatic rotator cuff re-tear [377]. In a study of 51 patients undergoing open repair, one patient had reoperation for arthrographically proven cuff rerupture 9 months after primary surgery [113].

Infection: Infections after rotator cuff repair are uncommon, with diagnosis usually made within 1 or 2 months of surgery [27]. The overall incidence was 8.5/1000 arthroscopic repairs over a 10-year period [306]. In a single-institution retrospective review, the rate of postoperative infection following primary arthroscopic repair was 0.11% [389]. Patients undergoing open repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic repair [364]. Arthroscopic repair is associated with a lower rate of postoperative infection compared with open or mini-open approaches [363], and it reduced the risk of infection compared with open techniques [366]. In a cohort of patients with diabetes mellitus, there were no cases of reoperation for infection identified [278]. In a study of 50 patients undergoing reoperation for symptomatic failure, one patient had severe deltoid scarring from an earlier postoperative infection [290]. In a study of patients aged 30 years and under, one patient had a delayed wound infection 2 weeks after a revision open rotator cuff repair [264].

Other Considerations: In a study of 51 patients undergoing open rotator cuff repair, there were no intraoperative complications and three postoperative complications [113]. Specifically, one patient had a huge subacromial ossification and required subacromial decompression 11 months after primary large cuff reconstruction [113]. One patient had recurrence of pain 3 months after surgery when starting strengthening exercises [113]. One patient had a third postoperative complication that was not fully detailed in the excerpt [113]. In a study of arthroscopic primary rotator cuff repairs in patients younger than 45 years, no intraoperative, perioperative, or postoperative complications were reported [128]. In a randomized controlled trial of 60 patients undergoing arthroscopic repair with or without synovectomy, no side effects were reported for the interventions [126]. In a prospective cohort of 1000 consecutive cases of undersurface rotator cuff repair, no patients required reoperation for infection or post-operative stiffness [392]. In a study of 50 patients undergoing reoperation for symptomatic failure, one patient had a permanent axillary nerve palsy from a concomitant dislocation and rotator cuff rupture [290]. In the same study, four patients had deltoid origin detachment with fixed distal retraction [290].

Recovery

Light activity (weeks): Patients can safely return to driving at 2 weeks postoperatively after rotator cuff repair, with no clinically important negative impact on driving fitness [228].

Full activity (months): The majority of injured workers undergoing rotator cuff repair return to previous work at approximately 8 months after surgery [149], and a vast majority of patients can expect to return to work within 8 months of surgery [171]. Arthroscopic rotator cuff repair resulted in high rates of return to work in a cohort of manual laborers, with 89.6% of patients able to return to work [185]. As much as 88.5% of patients were able to return to activities after arthroscopic rotator cuff repair with a mean duration of 6.59 months [247]. Return to full-duty work in geriatric workers' compensation patients after rotator cuff repair takes about 5 months regardless of surgical approach [224].

Complete recovery / outcome plateau (months): Most functional improvement and pain relief occur within the first 6 months, with improvements continuing to 24 months [30]. The plateau of maximum recovery following rotator cuff repair occurs at 1 year, with high satisfaction rates at all time points [168, 179]. Recovery of the ability to sleep comfortably plateaus at 6 months, and achieved improvements in sleep are maintained more than 4 years after rotator cuff repair without evidence for the re-emergence of sleep disturbance [358].

Rehabilitation protocol: There is no consensus on rehabilitation protocols following rotator cuff repair [170]. Early passive motion exercise is not mandatory after arthroscopic repair of small to medium-sized full-thickness rotator cuff tears [182]. Early rehabilitation after arthroscopic cuff repair is associated with some initial improvements in range of motion and function [183]. The currently available literature did not identify any significant differences in functional outcomes and relative risks of re-tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs [65]. Water therapy after rotator cuff repair provides better early results compared to traditional dry rehabilitation or self-exercise therapy [180]. The healing rate at long-term follow-up is not clearly affected by the type of rehabilitation, but the early passive motion protocol might result in lower rates of tendon healing in the shoulder with large-sized tendon tears [190]. A delayed postoperative physical therapy protocol was associated with improvements in outcome measures and shoulder function compared to the preoperative state, with rotator cuff healing demonstrated by MRI [146]. Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair [167].

Functional milestones: Functional recovery based on clinical outcomes shows approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair [186]. Arthroscopic repair of rotator cuff lesions provides functional recovery as early as 3 months, with further improvement over the first year and subsequent stabilization [335]. Patient-reported outcome measures demonstrate high responsiveness to rotator cuff repair surgery during the first 2 postoperative years, with the majority of gains occurring within the first 6 months [252]. Patients undergoing rotator cuff repair achieve milestones measured by the five most commonly asked questions on the PROMIS-UE CAT by 1-4 months postoperatively [326].

Other Considerations: At long-term follow-up of 15 years or more, patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable [18]. The functional results of all-arthroscopic rotator cuff repairs remain stable at an intermediate follow-up of 5 years [78]. At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears have increased, with better results for primary tendon repair [151]. Fifteen-year results indicate that tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears [29]. Early high functional scores after primary rotator cuff repair or reconstruction did not persist, with function lost as range of motion and strength decreased to less than preoperative values at 16 years [350]. A satisfactory long-term outcome can be achieved after repair of large and massive rotator cuff tears [369]. During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, with low revision rates [379]. One-year follow-up does not determine the long-term outcome of rotator cuff repair [71]. Six months after rotator cuff repair, patients who continued to work after injury but presurgery were the most likely to return to work at any level, and patients who had less strenuous preinjury levels of work were the most likely to return to their preinjury levels of work [231]. Workers' compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving workers' compensation benefits [214]. Preoperative mental health scores and achieving patient acceptable symptom state are predictive of return to work after arthroscopic rotator cuff repair [171]. Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence, with excellent healing rates in both shoulders [47]. At a minimum of 1-year follow-up after rotator cuff repair, patients should expect similar improvement in pain and validated outcome measures for each side, though they may experience more pain during the middle portion of recovery on the contralateral side [351]. Patients who are upper extremity ambulators demonstrate clinically significant improvements following rotator cuff repair despite apparent risks [70]. Rotator cuff repairs in spinal cord injury patients report favorable outcomes, with pain reduced and transfers performed with greater ease in 7 of 8 shoulders [253]. The short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to those after primary rotator cuff repair [5, 7, 20]. Partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention, with only 5% of patients undergoing subsequent surgery at an average of more than 4 years' follow-up [83]. Arthroscopic repair can be recommended in patients with massive rotator cuff tears because of the functional gain at midterm follow-up, despite a high rate of healing failures [372]. Subacromial injection of tranexamic acid demonstrated no impairment in tendon healing or function following arthroscopic rotator cuff repair at 2 years postoperative [55]. Bone marrow stimulation in the setting of primary arthroscopic rotator cuff repair has no significant effect on functional outcomes, healing, pain, or reoperation rates [87].

Key Evidence

• [L3] The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. [1] (10.1007/s11999-008-0585-9)
• [L4] The major indication for revision rotator cuff repair is the persistence of clinical symptoms, despite nonsurgical management, in the absence of substantial risk factors for failure. [2] (10.1055/b-0041-179892)
• [L5] The major indication for revision rotator cuff repair is the persistence of clinical symptoms despite nonsurgical management in the absence of substantial risk factors for failure. [4] (10.5435/00124635-201111000-00002)
• [L3] The short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to those after primary rotator cuff repair. [5] (10.1177/0363546514560729)
• [L4] Despite the availability of revision strategies and treatment options, the prevention of complications and successful primary rotator cuff repair results in better functional outcomes. [6] (10.2106/jbjs.rvw.17.00052)
• [L3] Short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. [7] (10.1016/j.jse.2015.05.015)
• [L5] [10] (10.1016/j.arthro.2013.07.265)
• [L4] Thus, rotator cuff repair may not alter natural history. [16] (10.2106/jbjs.oa.17.00043)
• [L4] At long-term follow-up (≥15 years), the patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable over a period of 15 years. [18] (10.1016/j.jse.2022.01.116)
• [L4] Despite the large number of outcomes and prognostic factors evaluated, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair due to low methodological quality of included studies. [19] (10.1007/s00167-015-3700-y)
• [L3] The short term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. [20] (10.1177/2325967114s00016)
• [L4] Rotator cuff repair has a low incidence of short-term complications. [21] (10.1016/j.arthro.2017.10.040)
• [L4] Arthroscopic rotator cuff repair has evolved into one of the most common orthopedic surgical procedures worldwide, yet there is still much work to be carried out to improve healing rates, outcomes, and long-term durability. [22] (10.1016/j.xrrt.2021.01.004)
• [L1] There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol. [23] (10.1177/1941738108331200)
• [L3] Recurrent rotator cuff tears are not uncommon after arthroscopic repair of large and massive tears. [25] (10.1177/0363546511413372)
• [L4] Infections after rotator cuff repair are uncommon, with diagnosis usually made within 1 or 2 months of surgery. [27] (10.1016/s1058-2746(99)90045-9)
• [L1] [29] (10.2106/jbjs.24.00065)
• [L2] Rotator cuff repairs provide sustained clinical improvement out past 5 years, with most functional improvement and pain relief occurring within the first 6 months but continuing to 24 months. [30] (10.1177/23259671221119222)
• [L4] Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome. [33] (10.1016/j.jse.2018.09.003)
• [L3] [36] (10.1177/17585732211041637)
• [L4] Several patient-specific factors influencing functional and radiologic outcome after rotator cuff repair have been identified. [37] (10.1016/j.jse.2014.01.001)
• [L5] For the treatment of large to massive rotator cuff repairs, not all partial repairs are equivalent. [39] (10.1016/j.arthro.2018.03.041)
• [L4] Every attempt should be made at the time of the arthroplasty to balance the soft tissues and securely repair the rotator cuff because subsequent attempts to repair the rotator cuff are prone to failure. [40] (10.1016/j.jse.2005.06.002)
• [L3] Short-term complications after rotator cuff repair are rare. [44] (10.1016/j.arthro.2017.10.027)
• [L4] Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. [47] (10.1016/j.jse.2016.01.027)
• [L4] Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority. [49] (10.1007/s00167-014-3445-z)
• [L3] Severely obese patients and their associated comorbid conditions pose unique challenges in rotator cuff tear management, but they still achieve overall excellent outcomes after repair and noninferior clinical differences when compared to healthy weight patients. [50] (10.1016/j.arthro.2022.02.026)
• [L3] [51] (10.1186/s12891-021-04304-7)
• [L3] These findings suggest that individual scapular morphology may influence both disease development and surgical outcomes of rotator cuff tears. [53] (10.1177/2325967116s00193)
• [L2] It demonstrated no impairment in tendon healing or function following arthroscopic rotator cuff repair at 2 years postoperative. [55] (10.1016/j.jisako.2025.100806)
• [L4] Use of these higher values should be considered when evaluating improvements of individual patients after rotator cuff repair, to determine comparative effectiveness of various rotator cuff repair techniques and to determine sample sizes for prospective comparative trials of rotator cuff repair methods. [57] (10.1016/j.jse.2019.11.018)
• [L4] Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. [58] (10.1007/s43465-020-00345-7)
• [L4] This technique represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable. [60] (10.1016/j.jse.2016.12.056)
• [L4] This technique represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable. [61] (10.1016/j.arthro.2016.03.037)
• [L1] We do not recommend doing routine DCR with arthroscopic rotator cuff repair. [62] (10.1016/j.otsr.2020.08.006)
• [L5] Shoulder surgeons must carefully interpret literature comparing open and arthroscopic rotator cuff repair outcomes, as differences in complications may be influenced by selection bias and narrowing indications for open repair. [64] (10.1016/j.arthro.2017.11.026)
• [L4] The currently available literature did not identify any significant differences in functional outcomes and relative risks of re-tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. [65] (10.2174/1874325001711010154)
• [L5] A healed rotator cuff repair results in a superior outcome for the patient compared with a non-healed repair, and the surgeon can maximize the chance of a healed repair by adhering to core principles regarding tear pattern recognition, repair construct selection, biological healing optimization, and avoiding aggressive early rehabilitation. [68] (10.1016/j.arthro.2018.11.002)
• [L4] Despite the apparent risks associated in rotator cuff repair in upper extremity ambulators, these patients demonstrate clinically significant improvements following surgery. [70] (10.1016/j.jseint.2022.08.015)
• [L5] One-year follow-up is not the last word for rotator cuff repair outcomes; patients must live with the long-term outcomes of surgical procedures, and authors are obliged to evaluate these long-term outcomes. [71] (10.1016/j.arthro.2024.12.040)
• [L5] Repeat cuff repair can improve pain and function when indicated, but outcomes are poorer than primary procedures if criteria such as small retear, good tissue quality, and no osteoarthritis are not met. [72] (10.1016/j.otsr.2018.06.012)
• [L1] Shoulder function was improved after complete rotator cuff repair and similar clinical outcomes were achieved regardless of suture anchor material and shape. [73] (10.1016/j.arthro.2019.08.049)
• [L1] While several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented rotator cuff repair, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations. [74] (10.1136/bmjopen-2020-039552)
• [L3] Retrospective and prospective evaluations of the outcome of rotator cuff repair are different. [75] (10.1016/j.jse.2008.04.003)
• [L3] CSA and AI do not appear to influence 24-month functional outcomes postoperatively and hence are not contraindications to arthroscopic rotator cuff repair. [76] (10.1177/0363546517717947)
• [L2] The data support the hypothesis that the functional results of all-arthroscopic rotator cuff repairs remain stable at an intermediate follow-up of 5 years. [78] (10.1016/j.jse.2011.03.029)
• [L4] Magnetic resonance imaging and ultrasound findings suggested increased tendon thickness and favorable structural healing, with reported healing rates up to 96% within 12–24 months. [79] (10.5397/cise.2025.01326)
• [L3] Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. [80] (10.1177/23259671221126095)
• [L4] Only 5% of patients underwent subsequent surgery at an average of more than 4 years' follow-up, suggesting that partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention. [83] (10.1016/j.asmr.2020.08.017)
• [L4] While concordance with MRI results are good for the supraspinatus, MRI often fails to diagnose the presence of subscapularis tears and infraspinatus tears. [84] (10.4103/0973-6042.91000)
• [L4] Biocomposite suture anchors are frequently still visible on MRI 2 years after rotator cuff reconstruction. [85] (10.1177/2325967117s00368)
• [L5] Revision rotator cuff repair is technically more difficult than primary repair due to poor tissue quality, adhesions, and retained hardware. [86] (10.1016/j.jse.2011.11.029)
• [L1] This meta-analysis of level I evidence demonstrates that bone marrow stimulation in the setting of primary arthroscopic rotator cuff repair has no significant effect on functional outcomes, healing, pain, or reoperation rates. [87] (10.1016/j.jse.2023.08.012)
• [L5] [88] (10.1016/j.eats.2024.103145)
• [L4] The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. [89] (10.1016/j.jse.2015.10.021)
• [L4] [96] (10.1016/j.asmr.2021.11.010)
• [L3] After rotator cuff repair, symptoms of depression/anxiety related to the shoulder improved dramatically with or without preexisting clinical diagnosis of depression or anxiety. [102] (10.1016/j.jse.2020.03.046)
• [L3] [111] (10.5435/jaaos-d-24-00646)
• [L4] [113] (10.1097/01.000093903.12372.3f)
• [L1] Evidence synthesized in this review underscores the importance of patient age, expectations, and the extent of the rotator cuff tear in influencing outcomes following rotator cuff repair. [121] (10.1186/s12891-025-08608-w)
• [L3] Glenohumeral decentering is significantly associated with diminished shoulder function and active range of motion in all planes. [122] (10.1016/j.jse.2025.03.038)
• [L4] At mid-term follow-up, greater preoperative rotator cuff disease severity was associated with failure to achieve clinically significant outcomes. [125] (10.1016/j.arthro.2023.06.031)
• [L1] [126] (10.1177/23259671261474635)
• [L3] The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. [127] (10.1186/s12891-023-06174-7)
• [L4] [128] (10.1016/j.arthro.2013.01.015)
• [L3] Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing and is not a positive predictor of outcomes following rotator cuff repair. [131] (10.1177/2325967116s00102)
• [Paper] [134] (10.1007/s12306-011-0175-y)
• [L4] Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function. [137] (10.1177/23259671221084294)
• [L5] In a dynamic biomechanical cadaveric model, increased glenohumeral joint loads due to a full-thickness SSP tear can be reversed with RCR. [138] (10.1016/j.arthro.2021.10.036)
• [L5] In contrast to a TOE repair of the supraspinatus tendon, isolated supraspinatus tears did not perturb glenohumeral kinematics in this cadaveric model of the throwing shoulder. [140] (10.1177/0363546514547348)
• [L5] Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair. [141] (10.5435/jaaos-d-17-00086)
• [Paper] Shoulder posture is an important determinant of passive forces during rotator cuff repair surgery. [142] (10.1016/j.clinbiomech.2011.04.005)
• [L4] Both techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome. [143] (10.1007/s00402-020-03584-3)
• [L4] The novel all-inside arthroscopic rotator cuff repair technique was safe and significantly faster and provided better healing rates than other repair techniques. [144] (10.1177/2325967119864088)
• [L4] The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI. [146] (10.3390/osteology1010003)
• [L3] Shoulder strength and patient-reported outcomes improved significantly over 24 months, but the glenohumeral joint contact center gradually shifted superiorly, potentially reflecting altered loading patterns or loss of dynamic stability despite functional improvements. [147] (10.1016/j.jseint.2025.101421)
• [L4] The majority of injured workers undergoing rotator cuff repair return to previous work at approximately 8 months after surgery. [149] (10.1177/0363546520975426)
• [L3] The healing of the rotator cuff using an anatomic technique was superior to that in the single row repair group. [150] (10.1016/j.arthro.2012.04.078)
• [L1] At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair. [151] (10.2106/jbjs.18.01373)
• [Paper] This technique of concomitant superior capsular reconstruction with rotator cuff repair has been a reproducible method for achieving successful surgical management of patients with massive rotator cuff tears and superior capsular insufficiency. [152] (10.1016/j.eats.2019.01.004)
• [L4] This technique represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable. [153] (10.1016/j.arthro.2011.03.020)
• [L3] Diagnostic performance of the modified Patte classification system was excellent for reparability and acceptable for rotator cuff healing, with high measurement reliability. [154] (10.1002/ksa.12162)
• [L3] This progress can be questioned, since there are not convincing data of the superiority of the operative treatment over non-operative management in all rotator cuff tears. [156] (10.1186/s12891-015-0639-6)
• [L5] The Hamada classification is a commonly used classification scheme that uses a mechanistic approach to explain the radiographic changes seen with chronic massive rotator cuff tears, highlighting the progressive nature of massive rotator cuff tears leading to CTA. [164] (10.1007/s11999-017-5340-7)
• [L2] Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair. [167] (10.1016/j.jse.2017.02.009)
• [L4] The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. [168] (10.1016/j.arthro.2017.04.033)
• [L2] It remains a safe and effective analgesia method during rotator cuff repair surgery. [169] (10.1016/j.otsr.2020.05.009)
• [Paper] The paper is a consensus paper based on an evidence-based evaluation of literature and expert opinions, noting that there is no consensus on rehabilitation protocols following rotator cuff repair. [170] (10.1007/s11678-018-0448-2)
• [L3] A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. [171] (10.1177/2325967119878415)
• [L3] [174] (10.1007/s11999-011-1896-9)
• [L2] It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair. [178] (10.1007/s00167-012-2272-3)
• [L4] The plateau of maximum recovery after rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. [179] (10.1016/j.jse.2016.11.002)
• [L1] Water therapy after rotator cuff repair provides better early results compared to traditional dry rehabilitation or self-exercise therapy. [180] (10.1177/2325967121s00007)
• [L1] Early passive motion exercise is not mandatory after arthroscopic repair of small to medium-sized full-thickness rotator cuff tears. [182] (10.1177/0363546511434287)
• [Paper] Early rehabilitation after arthroscopic cuff repair is associated with some initial improvements in ROM and function. [183] (10.1080/00913847.2015.1025683)
• [L4] Arthroscopic rotator cuff repair portended favorable outcomes and high rates of return to work in this cohort of manual laborers, with 89.6% of patients able to return to work. [185] (10.1177/03635465221097102)
• [L3] Functional recovery based on clinical outcomes showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair. [186] (10.1007/s00167-020-06019-z)
• [L3] Operative management of cuff tears is increasingly cost-effective with time, given nonrepaired cuff tears are unlikely to heal and portend worse symptomatology. [188] (10.1016/j.jseint.2025.04.038)
• [L1] The healing rate at long-term follow-up is not clearly affected by the type of rehabilitation, but the EPM protocol might result in lower rates of tendon healing in the shoulder with large-sized tendon tears. [190] (10.1097/md.0000000000009625)
• [L4] More significant increases in kinematics were observed at the 6-month evaluation than the 3-month evaluation, which is not aligned with the standard rehabilitation endpoint. [192] (10.1016/j.jelekin.2019.07.001)
• [L5] The widely accepted 2-year benchmark for rotator cuff repair outcomes may be arbitrary and does not add clinical relevance, as 1-year follow-up appears clinically sufficient. [194] (10.1016/j.arthro.2023.11.002)
• [L4] Despite the growing clinical use of scaffold devices for rotator cuff repair, numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy remain to be clarified or addressed. [195] (10.1016/j.jse.2011.10.003)
• [L5] The general indications for augmentation include patients with large (>3 cm), multitendon rotator cuff tears or chronic tears with poor tissue quality. [198] (10.1016/j.eats.2024.103287)
• [L4] Rotator cuff repair is cost-effective for all populations. [201] (10.2106/jbjs.l.01495)
• [L4] The RC repair group participants were able to accomplish the ADLs within the same time frame and through thoracohumeral joint kinematics similar to those in the healthy shoulder group participants. [204] (10.1016/j.pmrj.2016.08.031)
• [L3] Most shoulders with early motion loss recover motion and rarely require capsular release. [205] (10.1016/j.jse.2009.07.009)
• [L3] These results support both a trial of conservative treatment after a rotator cuff tear and a positive outcome of rotator cuff repair even if delayed by up to 12 weeks. [206] (10.1002/jor.20031)
• [L3] Thus, acromioplasty cannot be recommended as a routine technique in every rotator cuff repair. [210] (10.1080/00913847.2016.1216717)
• [L4] We conclude that outpatient rotator cuff repair can be a safe and successful procedure when performed in appropriately selected patients. [211] (10.1016/s1058-2746(00)90006-5)
• [L1] There is no evidence of difference in effectiveness between open and arthroscopic repair of rotator cuff tears. [212] (10.1302/0301-620x.99b1.bjj-2016-0424.r1)
• [L3] Workers' compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving workers' compensation benefits. [214] (10.1177/2309499018802507)
• [Paper] Radiographs should be the first imaging study obtained, and magnetic resonance imaging provides the best overall evaluation of the cuff. [215] (10.1016/j.csm.2012.07.010)
• [L5] This commentary highlights that while nonoperative treatment may yield better short-term outcomes, surgical repair provides significantly better long-term outcomes and a higher probability of substantial improvement for symptomatic rotator cuff tears, supporting its use in shared decision-making. [217] (10.2106/jbjs.20.00400)
• [L5] Multimodal analgesia for rotator cuff repair should be individualized based on surgical location, complexity, and patient comorbidity, with interscalene block preferred for complex anterior procedures unless respiratory comorbidities are present, in which case periarticular infiltration combined with pharmacologic therapies is recommended. [219] (10.1016/j.arthro.2024.06.010)
• [L4] These findings add to the growing body of evidence supporting the use of CISB for postoperative analgesia in patients undergoing rotator cuff repair. [221] (10.1177/0310057x0803600606)
• [L4] Return to full-duty work in geriatric workers' compensation patients after rotator cuff repair takes about 5 months regardless of surgical approach and costs significantly more in patients aged ≥ 65. [224] (10.1177/2151458517732209)
• [L1] The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. [225] (10.1007/s00167-016-4198-7)
• [L2] Patients showed no clinically important negative impact on driving fitness as early as 2 weeks after rotator cuff repair. [228] (10.2106/jbjs.21.01436)
• [L3] Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic rotator cuff injuries. [229] (10.1186/s13018-024-04858-x)
• [L3] Six months after rotator cuff repair, patients who continued to work after injury but presurgery were the most likely to return to work at any level, and patients who had less strenuous preinjury levels of work were the most likely to return to their preinjury levels of work. [231] (10.1177/03635465231152479)
• [L2] Following arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills over 6.9 days when used in combination with non-opioid pain medications. [237] (10.1016/j.asmr.2021.10.005)
• [L2] Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location. [240] (10.1016/j.jse.2014.12.009)
• [L4] Repair of symptomatic single-tendon rotator cuff tears in patients aged older than 65 years who do not respond to conservative treatment appears justified. [241] (10.1016/j.jse.2012.03.012)
• [L4] Despite Clinical Practice Guidelines recommending the nonroutine use of acromioplasty, surgeons continue to perform acromioplasty with rotator cuff repair in most of the cases throughout all subcategorizations analyzed. [242] (10.5435/jaaosglobal-d-22-00075)
• [L4] In 18 of 22 patients (82%) with partial-thickness rotator cuff tears treated with tear completion followed by surgical repair, there was no evidence of a full-thickness or near full–thickness defect on follow-up MRI at a minimum of 2 years. [246] (10.1016/j.arthro.2010.08.017)
• [L1] As much as 88.5% of patients were able to return to activities after arthroscopic rotator cuff repair with a mean duration of 6.59 months. [247] (10.1177/2325967121s00867)
• [L5] Multimodal pain therapy after rotator cuff repair provided at least equivalent pain relief compared to opioid analgesia, and standardized prescription protocols can decrease opioid consumption without reducing patient satisfaction. [248] (10.1016/j.arthro.2022.01.040)
• [L2] Resilience may be a valuable predictor of patients at risk of having suboptimal outcomes after rotator cuff repair and a target to improve surgical outcomes through non-surgical means. [250] (10.1177/17585732231170300)
• [L5] Multiple factors, including multimodal anesthesia strategies like the ISBPB-plus technique, can reduce opioid requirements after rotator cuff repair, though the optimal strategy has yet to be determined. [251] (10.1016/j.arthro.2024.09.017)
• [L2] All patient-reported outcome measures (PROMs) except SAL demonstrated high responsiveness to rotator cuff repair surgery during the first 2 postoperative years, with the majority of gains occurring within the first 6 months. [252] (10.1016/j.jse.2026.01.010)
• [L4] We report a favorable outcome for rotator cuff repairs in SCI patients, with pain reduced and transfers performed with greater ease in 7 of 8 shoulders. [253] (10.1016/s1058-2746(03)00035-1)
• [L4] [255] (10.1016/j.arthro.2006.09.001)
• [L1] Pre-incisional intra-articular morphine reduced pain in the first 2 weeks after arthroscopic rotator cuff repair. [258] (10.1007/s00402-015-2346-z)
• [L1] The study supports the use of gabapentin as an adjunct for pain management in open rotator cuff repair. [260] (10.1016/j.jse.2024.08.044)
• [L5] [261] (10.1002/jor.22853)
• [L4] One-stage treatment for rotator cuff tears in stiff shoulders provides comparable range of motion and patient-reported clinical outcomes as rotator cuff repair for non-stiff shoulders. [262] (10.1186/s13018-023-04104-w)
• [L3] On magnetic resonance imaging scans, seven rotator cuff repair failures (15.9%) were observed, with tear size identified as an independent predictor of re-rupture at one-year follow-up. [263] (10.1177/1758573220982607)
• [L4] [264] (10.1177/17585732241312192)
• [L3] [266] (10.1007/s00167-011-1520-2)
• [L1] Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair. [267] (10.1007/s00167-012-2202-4)
• [L4] After successful arthroscopic rotator cuff repair, there was a slight (11.3%-13.9%) increase in muscle volume from preoperatively to final follow-up, as seen on serial MRI. [269] (10.1177/0363546515625211)
• [L1] [270] (10.1177/0363546517695789)
• [L4] Despite a small patient cohort, this prospective pilot study suggests a temporal relationship of MRI and ultrasound parameters that parallels the expected phases of healing in the repaired rotator cuff. [273] (10.1002/jum.15583)
• [L3] [274] (10.1016/j.arthro.2013.12.018)
• [L5] Interscalene block is the undisputed gold-standard procedure for postoperative pain management after arthroscopic rotator cuff surgery in patients experiencing considerable pain, though the challenge remains to make this short-term total pain relief long-term. [276] (10.1016/j.arthro.2020.02.030)
• [L2] These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair. [277] (10.4055/cios.2015.7.2.234)
• [L3] [278] (10.1016/j.jse.2023.06.034)
• [L4] [279] (10.1177/2309499018768106)
• [L5] The author considers arthroscopic examination and attempted repair of large and massive rotator cuff tears to be the gold standard of treatment for nonarthritic shoulders, cautioning against the high complication and reoperation rates associated with reverse total shoulder replacements in younger patients. [280] (10.1016/j.arthro.2017.10.036)
• [Paper] DR rotator cuff repair has been shown to have improved tendon-bone healing rates on postoperative imaging, but it is unclear whether this translates to improved clinical outcomes. [281] (10.1097/bte.0000000000000100)
• [L2] Rotator cuff repairs augmented with a porcine dermal patch resulted in excellent clinical outcomes with a higher healing rate and close-to-normal MRI findings. [285] (10.1016/j.jse.2019.05.043)
• [L2] The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. [287] (10.3349/ymj.2015.56.3.772)
• [L4] [290] (10.1016/s1058-2746(09)80054-2)
• [L5] The authors maintain that magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair, regardless of the gold standard used, and that neither MRI nor clinical tests are sufficiently reliable in this context. [291] (10.1007/s00167-019-05775-x)
• [L4] These immediate changes should be considered when assessing rotator cuff muscle changes by comparing preoperative MRI with postoperative MRI. [292] (10.1016/j.arthro.2012.10.006)
• [L2] MRI appearance of the repaired tendon changes over time but does not correlate with function or predict clinical outcomes at 1 year after surgery. [293] (10.2214/ajr.10.4436)
• [L5] [294] (10.5435/jaaos-d-25-00069)
• [L5] [296] (10.1016/j.jse.2007.03.012)
• [L3] Although MRI data suggest improved healing rates in SR repairs in the entire patient population, DR repair showed improved radiographic healing when similar-sized tears were compared. [297] (10.1016/j.arthro.2010.03.013)
• [L5] [300] (10.1097/bte.0000000000000074)
• [L1] At a short-term follow-up, differences between arthroscopic repair of full-thickness rotator cuff tears with metal and biodegradable suture anchors were not significant. [302] (10.1016/j.arthro.2010.01.030)
• [L1] Smoking is associated with a higher risk of imaging-confirmed structural failure after arthroscopic rotator cuff repair. [303] (10.1016/j.jse.2026.04.050)
• [L3] The overall incidence of infection was 8.5/1000 arthroscopic rotator cuff repairs over a 10-year period. [306] (10.1007/s00167-016-4202-2)
• [L4] However, the presence of clinically significant disagreements, even in such favorable circumstances, indicates the need for improved imaging tools for precise rotator cuff evaluation. [309] (10.1016/j.jse.2021.04.021)
• [L4] [310] (10.1007/s12178-020-09658-4)
• [L4] Solid fixation of the rotator cuff tear was obtained in all cases. [311] (10.1097/bte.0b013e3181e2989c)
• [L3] Most deformities after rotator cuff repair remodel over time and do not affect the radiologic outcome of repair after 6 months of follow-up. [314] (10.1016/j.arthro.2013.07.023)
• [L5] Therefore, gap formation between the bone and the soft tissue fixation jeopardizes the repair, and the anchor is not appropriate for rotator cuff repair if used on its own. [319] (10.1016/j.jse.2007.11.017)
• [L4] Poor interobserver agreement regarding postoperative graft and rotator cuff integrity by MRI was found. [320] (10.1016/j.arthro.2021.11.008)
• [L4] Ultrasonography is an adequate imaging modality to classify rotator cuff repair integrity, which could reduce economic and practical burdens of CTA, MRI or MRA. [322] (10.1007/s00167-015-3505-z)
• [L3] [323] (10.1177/0363546518817764)
• [L4] The present study found that 50% of patients who underwent biologically enhanced DBM augmentation of their rotator cuff repair demonstrated MRI-determined failure of supraspinatus healing. [325] (10.3390/jcm11112956)
• [L3] On average, patients undergoing rotator cuff repair achieved milestones measured by the five most commonly asked questions on the PROMIS-UE CAT by 1-4 months postoperatively. [326] (10.1177/2325967121s00341)
• [L3] Magnetic resonance imaging is useful for the evaluation of patients who have pain and loss of function after a repair of the rotator cuff, particularly for identifying full-thickness tears, intact cuffs, ruptures of the biceps tendon, and detachments of the origin of the deltoid muscle, though it is less effective for partial-thickness tears. [327] (10.2106/00004623-199609000-00015)
• [L5] It highlights that initial fixation strength is an essential consideration in optimizing rotator cuff repair. [328] (10.4055/cios.2013.5.2.89)
• [L4] These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective. [329] (10.1016/j.jse.2018.03.011)
• [L1] There is no MRI difference in 12 month rotator cuff retear rates between triple-loaded single-row repairs or suture-bridging double-row repairs. [330] (10.1016/j.arthro.2016.03.038)
• [L3] In the community setting, ultrasound may be used to evaluate the integrity of a repaired rotator cuff tendon and constitutes a comparable alternative to MRI when evaluating the integrity of a rotator cuff repair. [332] (10.1016/j.jse.2014.01.045)
• [L4] Metal artefacts prevented accurate diagnosis from MRI scans of rotator cuff retear in 36% of the patients studied. [333] (10.1177/1758573217710833)
• [L4] Arthroscopic repair of rotator cuff lesions gives very good results in terms of functional recovery, with recovery as early as 3 months, further improvement over the first year, and subsequent stabilization. [335] (10.1016/j.arthro.2007.07.023)
• [L5] Every tested anchor presented different problems that may lead to premature failure of the rotator cuff reconstruction. [337] (10.1016/j.arthro.2009.12.023)
• [Paper] Superior capsular reconstruction with incorporation of the native rotator cuff may provide surgeons the opportunity to perform a robust repair in situations where arthroplasty or other more invasive procedures were once the only options. [338] (10.1016/j.eats.2018.04.005)
• [L3] No significant differences were found at a mean 3-year follow-up in the retear rates, pain, ROM, and glenohumer structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative CSIs. [341] (10.1177/03635465221145949)
• [L3] The shift angle and medial retraction of the deep layer on magnetic resonance imaging are associated with intraoperative reparability in large-to-massive rotator cuff tears. [342] (10.1002/ars2.70058)
• [L3] Arthroscopic rotator cuff repair could be indicated regardless of the appearance of the greater tuberosity if MRI showed lesser degrees of fatty degeneration. [343] (10.1016/j.jseint.2020.11.009)
• [L1] MRA is not suitable for the diagnosis of LHB lesions prior to arthroscopic rotator cuff repair. [344] (10.1007/s00167-019-05633-w)
• [L4] Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. [345] (10.1007/s00167-017-4595-6)
• [L1] After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery. [346] (10.1177/0363546515572602)
• [L5] The ideal rotator cuff repair technique should have high initial fixation strength to allow minimal gap formation between the tendon and bone. [347] (10.1177/23259671211006040)
• [L4] The early high functional scores after primary rotator cuff repair or reconstruction did not persist; function was lost as ROM and strength decreased to less than preoperative values. [350] (10.1007/s11999-010-1403-8)
• [L5] At a minimum of 1-year follow-up after rotator cuff repair, patients should expect similar improvement in pain and validated outcome measures for each side, though they may experience more pain during the middle portion of recovery on the contralateral side. [351] (10.1016/j.arthro.2018.07.025)
• [L3] Arthroscopic transosseous rotator cuff repair achieves similar clinical outcomes, patient-reported outcomes, and healing rates with 30-80% reduction in implant costs, compared to traditional anchored techniques. [352] (10.1016/j.arthro.2016.03.084)
• [L3] Both anchor insertion techniques resulted in acceptable shoulder clinical outcomes for patients with osteoporosis undergoing rotator cuff repair. [355] (10.1177/23259671251408497)
• [L4] Although recovery of the ability to sleep comfortably plateaued at 6 months, the achieved improvements in sleep are maintained more than 4 years after rotator cuff repair without evidence for the re-emergence of sleep disturbance. [358] (10.1016/j.jse.2024.05.043)
• [L5] Clinical registries are a highly beneficial source of information showing that adverse events after rotator cuff repair may occur in almost 1 of 5 cases, but retrospective review of registry data has limitations including inconsistent reporting, lack of control of confounding variables, and loss to follow-up. [362] (10.1016/j.arthro.2020.10.045)
• [L5] Arthroscopic rotator cuff repair is associated with a lower rate of postoperative infection compared with open or mini-open approaches, but the preponderance of male patients among infections requires further research to determine effective preventive strategies. [363] (10.1016/j.arthro.2015.12.034)
• [L3] Patients undergoing open rotator cuff repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic rotator cuff repair. [364] (10.1177/2325967117715416)
• [L4] Arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. [366] (10.1016/j.arthro.2015.08.021)
• [L4] A satisfactory long-term outcome can be achieved after repair of large and massive rotator cuff tears. [369] (10.1016/s1058-2746(98)90081-7)
• [L4] Despite a high rate of healing failures, arthroscopic repair can be recommended in patients with massive rotator cuff tears because of the functional gain at midterm follow-up. [372] (10.1177/0363546513485719)
• [L4] Pooled analysis demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. [374] (10.1177/03635465211073332)
• [L3] The incidence of re-interventions was 10% and the main cause was a symptomatic rotator cuff re-tear. [377] (10.1016/j.jse.2021.03.051)
• [L4] During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. [379] (10.1016/j.arthro.2018.09.026)
• [L4] Through this single-institution, large cohort retrospective review, we found an overall 0.11% rate of postoperative infection following primary arthroscopic RCR. [389] (10.1016/j.asmr.2021.08.014)
• [L4] Seven patients (0.7%) underwent revision rotator cuff repair, and no patients required reoperation for infection or post-operative stiffness. [392] (10.1016/j.jseint.2026.101778)
• [L4] A decrease in retear rate after arthroscopic rotator cuff repair occurred during the study period. [395] (10.1016/j.jses.2019.01.002)

See Also

• Rotator Cuff
• Revision rotator cuff repair
• Cuff Arthropathy
• Capsular Release for Frozen Shoulder
• Shoulder Arthroscopy
• Reverse Shoulder Arthroplasty
• Subacromial Decompression

References

[1] Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-008-0585-9

[2] Arthroscopic Revision Rotator Cuff Repair. Video Atlas of Arthroscopic Rotator Cuff Repair. 2021. DOI: 10.1055/b-0041-179892

[3] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > PARTIAL-THICKNESS ROTATOR CUFF TEARS.

[4] Arthroscopic Revision Rotator Cuff Repair. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201111000-00002

[5] Revision Versus Primary Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514560729

[6] Complications Following Arthroscopic Rotator Cuff Repair and Reconstruction. JBJS Reviews. 2018. DOI: 10.2106/jbjs.rvw.17.00052

[7] Primary vs. Revision Arthroscopic Rotator Cuff Repair: An Analysis in 360 Consecutive Patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.015

[8] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > Indications for Rotator Cuff Repair.

[9] Apley And Solomon S Concise System Of Orthopaedics And Trauma. DISORDERS OF THE ROTATOR CUFF.

[10] Management of Disorders of the Rotator Cuff: Proceedings of the ISAKOS Upper Extremity Committee Consensus Meeting. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.07.265

[12] Orthopaedic Knowledge Update Sports Medicine 6. Rotator Cuff Disease > Annotated References.

[15] Classifications And Scores Of The Shoulder. 5.7 Classification of the extent of rotator cuff tears according to Patte [107].

[16] The Effect of Rotator Cuff Repair on Natural History. JBJS Open Access. 2018. DOI: 10.2106/jbjs.oa.17.00043

[17] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > FULL-THICKNESS ROTATOR CUFF TEARS.

[18] Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.116

[19] Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3700-y

[20] Primary Versus Revision Arthroscopic Rotator Cuff Repair - An Analysis In 350 Consecutive Patients. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00016

[21] Risk Factors for Short‐term Complications After Rotator Cuff Repair in the United States. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.10.040

[22] Current concepts in the evolution of arthroscopic rotator cuff repair. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2021.01.004

[23] Rotator Cuff Repair Rehabilitation: A Level I and II Systematic Review. Sports Health: A Multidisciplinary Approach. 2009. DOI: 10.1177/1941738108331200

[25] When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546511413372

[26] Aaos Comprehensive Orthopaedic Review 3. Rotator Cuff Tears and Cuff Tear Arthropathy > I. Rotator Cuff Tears.

[27] Infection after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90045-9

[29] Fifteen-Year Results of a Comparative Analysis of Tendon Repair Versus Physiotherapy for Small-to-Medium-Sized Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.24.00065

[30] Do Age, Demographics, and Tear Characteristics Affect Outcomes After Rotator Cuff Repair? Results of Over 2000 Rotator Cuff Repairs at 5-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221119222

[33] Long-term results after arthroscopic transosseous rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.09.003

[36] Tear size, general health status and smoking influence functional outcome at 5 years following arthroscopic rotator cuff repair. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211041637

[37] Specific patient-related prognostic factors for rotator cuff repair: a systematic review. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.001

[39] Editorial Commentary: What's in a Name: Is There a Difference Between Incomplete and Partial Rotator Cuff Repairs?. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.03.041

[40] Rotator cuff repair after shoulder replacement. Journal of Shoulder and Elbow Surgery. 2006. DOI: 10.1016/j.jse.2005.06.002

[44] Comparison of Short‐term Complications After Rotator Cuff Repair: Open Versus Arthroscopic. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.10.027

[47] Functional outcomes after bilateral arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.01.027

[49] History of rotator cuff surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3445-z

[50] Severe Obesity Is Not Associated With Worse Functional Outcomes Following Arthroscopic Rotator Cuff Repair. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.02.026

[51] Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04304-7

[53] Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome after Rotator Cuff Repair?. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00193

[55] Subacromial Injection of Tranexamic Acid Improves Early Postoperative Range of Motion Without Decreases the Tendon’s Healing in Arthroscopic Rotator Cuff Repair. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100806

[57] Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.018

[58] The Relevance of Open Rotator Cuff Repair in 2021. Indian Journal of Orthopaedics. 2021. DOI: 10.1007/s43465-020-00345-7

[60] Partial rotator cuff repair in massive rotator cuff tears: long-term follow-up. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.056

[61] Arthroscopic Partial Rotator Cuff Repair in the Management of Massive Rotator Cuff Tears: Long‐term Follow‐up. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.037

[62] Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.08.006

[64] Editorial Commentary: Don't Throw Away the Retractors: Complications of Open Versus Arthroscopic Rotator Cuff Repair Could Be Influenced by Indications. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.11.026

[65] Rehabilitation after Rotator Cuff Repair. The Open Orthopaedics Journal. 2017. DOI: 10.2174/1874325001711010154

[68] Arthroscopic Rotator Cuff Repair: How to Avoid Retear. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2018.11.002

[69] Orthopaedic Basic Science Fifth Edition Print Ebook. Lumbar Spondylosis, Degenerative Disk Disease, and Radiculopathy > Clinical Example: Rotator Cuff Repair.

[70] Rotator cuff repair in upper extremity ambulators: an assessment of longitudinal outcomes. JSES International. 2022. DOI: 10.1016/j.jseint.2022.08.015

[71] Editorial Commentary: One‐Year Follow‐Up Does Not Determine Rotator Cuff Repair Long‐Term Outcome. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.12.040

[72] Failed rotator cuff repair. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2018.06.012

[73] A Comparison of Open‐Construct PEEK Suture Anchor and Non‐Vented Biocomposite Suture Anchor in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.08.049

[74] Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis. BMJ Open. 2020. DOI: 10.1136/bmjopen-2020-039552

[75] A comparison of prospective and retrospective assessment of functional outcome after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2008.04.003

[76] Critical Shoulder Angle and Acromial Index Do Not Influence 24-Month Functional Outcome After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517717947

[78] Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I - Functional outcomes and radiographic healing rates. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.03.029

[79] Bioinductive collagen scaffolds for partial- and full-thickness rotator cuff repair: a systematic review. Clinics in Shoulder and Elbow. 2026. DOI: 10.5397/cise.2025.01326

[80] Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221126095

[83] Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.08.017

[84] The frequency of subscapularis tears in arthroscopic rotator cuff repairs: A retrospective study comparing magnetic resonance imaging and arthroscopic findings. International Journal of Shoulder Surgery. 2011. DOI: 10.4103/0973-6042.91000

[85] Biodegradation of Biocomposite Suture Anchor Implants 2,2 years after Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00368

[86] Current concepts review: revision rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.029

[87] Bone channeling in arthroscopic rotator cuff repair: a systematic review and meta-analysis of level I studies. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.08.012

[88] The Mason‐Loop for Single‐Row Full‐Thickness Rotator Cuff Repair. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103145

[89] Three-dimensional shoulder kinematics normalize after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.10.021

[91] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > RELEVANT SHOULDER ANATOMY > Rotator Cuff.

[94] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Rotator Cuff.

[96] Rotator Cuff Repair in the Pediatric Population Displays Favorable Outcomes: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2021.11.010

[102] Patients with depression and anxiety symptoms from adjustment disorder related to their shoulder may be ideal patients for arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.03.046

[111] Determinants of Patient-Rated Benefit 6 Months Post Arthroscopic Rotator Cuff Repair: An Analysis of 2010 Patients. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00646

[113] Functional and Electromyographic Results After Open Rotator Cuff Repair. Clinical Orthopaedics and Related Research. 2003. DOI: 10.1097/01.000093903.12372.3f

[114] Apley And Solomon S Concise System Of Orthopaedics And Trauma. SUPRASPINATUS IMPINGEMENT, SUPRASPINATUS TENDINITIS AND TEARS OF THE ROTATOR CUFF.

[116] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Rotator Cuff Tears > Surgical Findings.

[121] Patient-specific risk factors for repair failure and poor functional outcome after rotator cuff repair - an umbrella review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-08608-w

[122] Glenohumeral decentering in rotator cuff deficiency: relationship to rotator cuff muscle, scapula morphology, and shoulder function. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.03.038

[125] Quantifying Threshold Scores for Patient Satisfaction After Massive Rotator Cuff Repair for the Interpretation of Mid‐Term Patient‐Reported Outcomes. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.06.031

[126] The Efficacy of Synovectomy in Rotator Cuff Repair: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261474635

[127] “Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears”. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06174-7

[128] Arthroscopic Primary Rotator Cuff Repairs in Patients Aged Younger Than 45 Years. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.01.015

[131] Teres Minor Hypertrophy is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00102

[134] Complications associated with arthroscopic rotator cuff repair: a literature review. MUSCULOSKELETAL SURGERY. 2011. DOI: 10.1007/s12306-011-0175-y

[137] In Vivo Static Retraction and Dynamic Elongation of Rotator Cuff Repair Tissue After Surgical Repair: A Preliminary Analysis at 3 Months. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221084294

[138] Increased Glenohumeral Joint Loads Due to a Supraspinatus Tear Can Be Reversed With Rotator Cuff Repair: A Biomechanical Investigation. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2021.10.036

[140] The Effect of Supraspinatus Tears on Glenohumeral Translations in Passive Pitching Motion. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514547348

[141] Management of Failed Rotator Cuff Repair in Young Patients. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-17-00086

[142] Postural dependence of passive tension in the supraspinatus following rotator cuff repair: A simulation analysis. Clinical Biomechanics. 2011. DOI: 10.1016/j.clinbiomech.2011.04.005

[143] The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03584-3

[144] A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119864088

[146] Delayed Rehabilitation Protocol after Rotator Cuff Repair. Osteology. 2020. DOI: 10.3390/osteology1010003

[147] Longitudinal analysis of rotator cuff repair: joint kinematics and clinical outcomes. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101421

[149] Return to Work After Primary Rotator Cuff Repair: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2021. DOI: 10.1177/0363546520975426

[150] Serial Ultrasound Evaluation of Tendon Healing of Anatomic Rotator Cuff Repair Compared to Single Row Repair in Patients Over 65 (SS‐18). Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.078

[151] At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.01373

[152] Superior Capsular Reconstruction With Arthroscopic Rotator Cuff Repair in a “Functional Biologic Augmentation” Technique to Treat Massive Atrophic Rotator Cuff Tears. Arthroscopy Techniques. 2019. DOI: 10.1016/j.eats.2019.01.004

[153] Partial Rotator Cuff Repair in Massive Rotator Cuff Tears: Long‐Term Follow‐Up (SS‐17). Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.020

[154] A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12162

[156] Increasing incidence of rotator cuff repairs—A nationwide registry study in Finland. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0639-6

[157] Miller S Review Of Orthopaedics. ROTATOR CUFF DISEASE > 4. Imaging.

[163] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Glenohumeral Joint > The Rotator Cuff.

[164] Classifications in Brief: Hamada Classification of Massive Rotator Cuff Tears. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-017-5340-7

[167] A systematic review of cost-effective treatment of postoperative rotator cuff repairs. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.02.009

[168] Speed of Recovery After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.033

[169] How periarticular corticosteroid injections impact the integrity of arthroscopic rotator cuff repair. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.05.009

[170] Rehabilitation following rotator cuff repair. Obere Extremität. 2018. DOI: 10.1007/s11678-018-0448-2

[171] Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119878415

[174] A Radiographic Classification of Massive Rotator Cuff Tear Arthritis. Clinical Orthopaedics & Related Research. 2011. DOI: 10.1007/s11999-011-1896-9

[178] Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2272-3

[179] Speed of recovery after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.002

[180] Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00007

[182] Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546511434287

[183] Early versus delayed rehabilitation following arthroscopic rotator cuff repair: A systematic review. The Physician and Sportsmedicine. 2015. DOI: 10.1080/00913847.2015.1025683

[185] Rates of Return to Manual Labor After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221097102

[186] Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06019-z

[188] Cost-effectiveness of rotator cuff repair based on modern constructs, tear size, and implant cost at 1, 5, and 10 years. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.038

[190] The clinical effect of rehabilitation following arthroscopic rotator cuff repair. Medicine. 2018. DOI: 10.1097/md.0000000000009625

[192] Shoulder complex kinematics pre- and post- rotator cuff repair. Journal of Electromyography and Kinesiology. 2022. DOI: 10.1016/j.jelekin.2019.07.001

[194] Editorial Commentary: One‐ and 2‐Year Outcomes Are Clinically Similar After Rotator Cuff Repair: What Are We Waiting For?. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.11.002

[195] Scaffold devices for rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.10.003

[198] A Technique for Arthroscopic Double‐Row Rotator Cuff Repair With Acellular Dermal Matrix Augmentation. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103287

[201] The Societal and Economic Value of Rotator Cuff Repair. Journal of Bone and Joint Surgery. 2013. DOI: 10.2106/jbjs.l.01495

[204] Assessment of Kinematics and Electromyography Following Arthroscopic Single‐Tendon Rotator Cuff Repair. PM&R. 2016. DOI: 10.1016/j.pmrj.2016.08.031

[205] Range of motion limitation after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.009

[206] Delay of supraspinatus repair by up to 12 weeks does not impair enthesis formation: A quantitative histologic study in rabbits. Journal of Orthopaedic Research. 2005. DOI: 10.1002/jor.20031

[210] Rotator Cuff Repair: Is there any role for acromioplasty?. The Physician and Sportsmedicine. 2016. DOI: 10.1080/00913847.2016.1216717

[211] Rotator cuff repair as an outpatient procedure. Journal of Shoulder and Elbow Surgery. 2000. DOI: 10.1016/s1058-2746(00)90006-5

[212] Effectiveness of open and arthroscopic rotator cuff repair (UKUFF). The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b1.bjj-2016-0424.r1

[213] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Instability, Rotator Cuff Disorders, Muscular Ruptures, Adhesive Capsulitis, Calcific Tendinitis > Rotator Cuff Tears > Evaluation.

[214] Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study. Journal of Orthopaedic Surgery. 2018. DOI: 10.1177/2309499018802507

[215] Imaging Evaluation of the Rotator Cuff. Clinics in Sports Medicine. 2012. DOI: 10.1016/j.csm.2012.07.010

[217] Rotator Cuff Repair Over Nonoperative Management: The Prudent Choice for Symptomatic Rotator Cuff Tears in the Shared Decision-Making Model. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00400

[219] Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.010

[221] Continuous Interscalene Analgesia for Rotator Cuff Repair: A Retrospective Comparison of Effectiveness and Cost in 205 Patients from a Multi-Provider Private Practice Setting. Anaesthesia and Intensive Care. 2008. DOI: 10.1177/0310057x0803600606

[224] A Review of a Workers’ Compensation Database 2003 to 2013: Patient Factors Influencing Return to Work and Cumulative Financial Claims After Rotator Cuff Repair in Geriatric Workers’ Compensation Cases. Geriatric Orthopaedic Surgery & Rehabilitation. 2017. DOI: 10.1177/2151458517732209

[225] Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4198-7

[228] Patients Who Undergo Rotator Cuff Repair Can Safely Return to Driving at 2 Weeks Postoperatively. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.21.01436

[229] Comparison of functional outcomes following early and delayed arthroscopic repair for traumatic and non-traumatic rotator cuff injuries. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04858-x

[231] Predictors of Return to Work Following Primary Arthroscopic Rotator Cuff Repair: An Analysis of 1502 Cases. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231152479

[234] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > ARTHROSCOPIC ROTATOR CUFF REPAIR.

[237] Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.10.005

[238] Orthopaedic Knowledge Update Sports Medicine 6. Rotator Cuff Disease > Biomechanics, Anatomy, and Genetics.

[240] Administration of analgesics after rotator cuff repair: a prospective clinical trial comparing glenohumeral, subacromial, and a combination of glenohumeral and subacromial injections. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.009

[241] Outcome of single-tendon rotator cuff repair in patients aged older than 65 years. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.03.012

[242] Trends in Acromioplasty Utilization During Arthroscopic Rotator Cuff Repair: An Epidemiological Study of 139,586 Patients. JAAOS: Global Research and Reviews. 2022. DOI: 10.5435/jaaosglobal-d-22-00075

[243] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Instability, Rotator Cuff Disorders, Muscular Ruptures, Adhesive Capsulitis, Calcific Tendinitis > Rotator Cuff Tears > Natural History.

[246] Magnetic Resonance Imaging Tendon Integrity Assessment After Arthroscopic Partial‐Thickness Rotator Cuff Repair. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.08.017

[247] Return to Activities after Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967121s00867

[248] Editorial Commentary: Multimodal, Opioid‐Free Pain Management After Rotator Cuff Repair May Be Safe and Effective, and Decreases the Risk of Drug Abuse. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.01.040

[250] Resilience correlates with patient-reported outcome measures at a minimum of 2 years after arthroscopic rotator cuff repair. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231170300

[251] Editorial Commentary: Multiple Factors, Including Multimodal Anesthesia, Can Reduce Opioid Requirements After Rotator Cuff Repair. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.09.017

[252] Comparative responsiveness of shoulder patient-reported outcome measures (PROMs) to rotator cuff repair surgery and healing. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.010

[253] Rotator cuff repair in spinal cord injury patients. Journal of Shoulder and Elbow Surgery. 2003. DOI: 10.1016/s1058-2746(03)00035-1

[255] Complications After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.09.001

[258] Effect of preemptive intra-articular morphine and ketamine on pain after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled study. Archives of Orthopaedic and Trauma Surgery. 2015. DOI: 10.1007/s00402-015-2346-z

[260] Assessment of the impact of gabapentin on postoperative pain following shoulder open rotator cuff repair: a double-blind clinical trial. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.08.044

[261] Tendon regeneration and scar formation: The concept of scarless healing. Journal of Orthopaedic Research. 2015. DOI: 10.1002/jor.22853

[262] One-stage rotator cuff repair in stiff shoulders shows comparable range of motion, clinical outcome and retear rates to non-stiff shoulders: a systematic review. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04104-w

[263] Clinical outcomes and structural integrity rate of arthroscopic augmented rotator cuff repairs using extracellular porcine matrix patch. Shoulder & Elbow. 2021. DOI: 10.1177/1758573220982607

[264] Full-thickness arthroscopic rotator cuff repair demonstrates low repair failure rates and high return to sport rates in patients aged 30 years and under at 9-year follow-up: A single-center case series. Shoulder & Elbow. 2025. DOI: 10.1177/17585732241312192

[266] The effect of multiple channeling on the structural integrity of repaired rotator cuff. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1520-2

[267] Randomized, controlled trial of multimodal shoulder injection or intravenous patient‐controlled analgesia after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2202-4

[269] Reversibility of Supraspinatus Muscle Atrophy in Tendon-Bone Healing After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546515625211

[270] Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517695789

[273] Ultrasound‐MRI Correlation for Healing of Rotator Cuff Repairs Using Power Doppler, Sonographic Shear Wave Elastography and MR Signal Characteristics. Journal of Ultrasound in Medicine. 2020. DOI: 10.1002/jum.15583

[274] Does Autologous Leukocyte‐Platelet–Rich Plasma Improve Tendon Healing in Arthroscopic Repair of Large or Massive Rotator Cuff Tears?. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2013.12.018

[276] Editorial Commentary: Postoperative Pain Management After Arthroscopic Rotator Cuff Repair: The Journey to Pain Relief. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.02.030

[277] Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair. Clinics in Orthopedic Surgery. 2015. DOI: 10.4055/cios.2015.7.2.234

[278] Elevated HbA1c is not associated with reoperation following arthroscopic rotator cuff repair in patients with diabetes mellitus. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.034

[279] Osteoarthritis progression of the shoulder: A long-term follow-up after mini-open rotator cuff repair. Journal of Orthopaedic Surgery. 2018. DOI: 10.1177/2309499018768106

[280] Editorial Commentary: Put Down Your Saw and Pick Up Your Scope! Or, Why Burn Down the Bridge When the Road Ahead Is Full of Potholes? Reverse Total Shoulder Replacement Versus Arthroscopic Rotator Cuff Repair. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.10.036

[281] Single-row Rotator Cuff Repair: SpeedFix and Triple-loaded Anchor. Techniques in Shoulder & Elbow Surgery. 2017. DOI: 10.1097/bte.0000000000000100

[285] Prospective randomized controlled trial for patch augmentation in rotator cuff repair: 24-month outcomes. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.05.043

[287] Effect of a Sleep Aid in Analgesia after Arthroscopic Rotator Cuff Repair. Yonsei Medical Journal. 2015. DOI: 10.3349/ymj.2015.56.3.772

[290] Reoperation for failed rotator cuff repair: Analysis of fifty cases. Journal of Shoulder and Elbow Surgery. 1992. DOI: 10.1016/s1058-2746(09)80054-2

[291] Diagnostic accuracy of magnetic resonance arthrography to assess biceps pathologies prior to rotator cuff repair: response to the Letter to the Editor. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05775-x

[292] Changes in Appearance of Fatty Infiltration and Muscle Atrophy of Rotator Cuff Muscles on Magnetic Resonance Imaging After Rotator Cuff Repair: Establishing New Time‐Zero Traits. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.10.006

[293] Temporal Evolution of MRI Findings After Arthroscopic Rotator Cuff Repair. American Journal of Roentgenology. 2010. DOI: 10.2214/ajr.10.4436

[294] Orthobiologic Augmentation to Improve Rotator Cuff Repair Outcomes: Current and Future Strategies. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00069

[296] Biologic augmentation of rotator cuff tendon repair. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.03.012

[297] Comparative Analysis of Single‐Row Versus Double‐Row Repair of Rotator Cuff Tears. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.03.013

[300] Massive Rotator Cuff Repair With All-Arthroscopic Patch Augmentation: A Surgical Technique. Techniques in Shoulder & Elbow Surgery. 2016. DOI: 10.1097/bte.0000000000000074

[302] Arthroscopic Rotator Cuff Repair With Metal and Biodegradable Suture Anchors: A Prospective Randomized Study. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.030

[303] Impact of Smoking on Structural Failure After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis". Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.050

[306] Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4202-2

[309] Inter-rater agreement of rotator cuff tendon and muscle magnetic resonance imaging parameters evaluated preoperatively and during the first postoperative year following rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.04.021

[310] Patch Augmentation in Rotator Cuff Repair. Current Reviews in Musculoskeletal Medicine. 2020. DOI: 10.1007/s12178-020-09658-4

[311] Rotator Cuff Repair Associated With Large Greater Tuberosity Bone Cysts: A Report of 3 Cases, Surgical Technique, and Review of the Literature. Techniques in Shoulder & Elbow Surgery. 2010. DOI: 10.1097/bte.0b013e3181e2989c

[314] Paper #19: Does The Deformity After Rotator Cuff Repair Remodel?. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.07.023

[319] Biomechanical testing of a new knotless suture anchor compared with established anchors for rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.11.017

[320] Prospective 1-Year Outcomes Are Maintained at Short-Term Final Follow-Up After Superior Capsular Reconstruction Augmentation of Complete Rotator Cuff Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2021.11.008

[322] Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double‐row rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3505-z

[323] Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546518817764

[325] Clinical Outcomes following Biologically Enhanced Demineralized Bone Matrix Augmentation of Complex Rotator Cuff Repair. Journal of Clinical Medicine. 2022. DOI: 10.3390/jcm11112956

[326] PROMIS Milestones in Patients Undergoing Rotator Cuff Repair (233). Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00341

[327] Magnetic Resonance Imaging for Evaluation of Failed Repairs of the Rotator Cuff. Relationship to Operative Findings. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199609000-00015

[328] Current Biomechanical Concepts for Rotator Cuff Repair. Clinics in Orthopedic Surgery. 2013. DOI: 10.4055/cios.2013.5.2.89

[329] Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.03.011

[330] Triple‐Loaded Single‐Row versus Suture‐Bridge Double‐Row Rotator Cuff Tendon Repair with Platelet Rich Plasma Fibrin Membrane: A Randomized Control Trial. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.038

[332] Assessment of rotator cuff repair integrity using ultrasound and magnetic resonance imaging in a multicenter study. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.045

[333] Metal artefacts severely hamper magnetic resonance imaging of the rotator cuff tendons after rotator cuff repair with titanium suture anchors. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217710833

[335] The Time for Functional Recovery After Arthroscopic Rotator Cuff Repair: Correlation With Tendon Healing Controlled by Computed Tomography Arthrography. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.023

[337] Biomechanical Stability of Knotless Suture Anchors Used in Rotator Cuff Repair in Healthy and Osteopenic Bone. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.12.023

[338] Arthroscopic Superior Capsular Reconstruction and Over‐the‐Top Rotator Cuff Repair Incorporation for Treatment of Massive Rotator Cuff Tears. Arthroscopy Techniques. 2018. DOI: 10.1016/j.eats.2018.04.005

[341] Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465221145949

[342] Shift Angle and Medial Retraction of the Deep Layer on Magnetic Resonance Imaging Are Associated With Intraoperative Reparability in Arthroscopic Rotator Cuff Repair. Arthroscopy, Sports Medicine, and Rehabilitation. 2026. DOI: 10.1002/ars2.70058

[343] Relationship between the morphology of the greater tuberosity and radiological and clinical outcomes after arthroscopic rotator cuff repair. JSES International. 2021. DOI: 10.1016/j.jseint.2020.11.009

[344] Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05633-w

[345] Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4595-6

[346] Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair?. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515572602

[347] Biomechanical Properties of Double-Row Transosseous Rotator Cuff Repair Combined With the Cinch Stitch in the Lateral Row. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211006040

[350] Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years. Clinical Orthopaedics & Related Research. 2010. DOI: 10.1007/s11999-010-1403-8

[351] Editorial Commentary: The Second Side Is as Good as the First After Bilateral Rotator Cuff Repair: Preach Patience to the Patients. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.07.025

[352] Arthroscopic Transosseous Anchorless vs Anchored Rotator Cuff Repair: A Comparison of Clinical and Patient Reported Outcomes, Structural Integrity, and Costs. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.084

[355] 20° Anchor Insertion Technique Toward the Subchondral Bone in Rotator Cuff Repairs for Patients With Osteoporosis Compared With the Traditional 45° Deadman Angle. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251408497

[358] Improvement in sleep disturbance following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.043

[362] Editorial Commentary: Adverse Events After Rotator Cuff Repair Are Not Rare: Houston, We (May) Have a Problem. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2020.10.045

[363] Editorial Commentary: Arthroscopic Rotator Cuff Repair—Infection Rate After Rotator Cuff Repair With Arthroscopic, Open, and Mini‐open Techniques. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.12.034

[364] Infection Rates in Arthroscopic Versus Open Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117715416

[366] Risk Factors for Infection After Rotator Cuff Repair. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.08.021

[369] 21 Long-term functional outcome following large and massive rotator cuff repair. Journal of Shoulder and Elbow Surgery. 1998. DOI: 10.1016/s1058-2746(98)90081-7

[372] Arthroscopic Repair of Massive Rotator Cuff Tears. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513485719

[374] A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465211073332

[377] Recurrent Instability in Patients with a Rotator Cuff Repair After a Traumatic Shoulder Dislocation. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.051

[379] Long‐Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.09.026

[389] Retrospective Analysis of Patients Undergoing Arthroscopic Rotator Cuff Repair at a Single Institution Yields a 0.11% Postoperative Infection Rate. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.08.014

[392] Undersurface rotator cuff repair for partial-thickness tears using the Opus knotless system: a prospective cohort of 1000 consecutive cases with a 1.4% retear rate. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101778

[395] Are we getting any better? A study on repair integrity in 1600 consecutive arthroscopic rotator cuff repairs. JSES Open Access. 2019. DOI: 10.1016/j.jses.2019.01.002