• Bioinductive patch
• bovine patch
• collagen patch
• review
• review of the literature
• rotator cuff patch
• rotator cuff repair

• Humans
• Collagen/administration & dosage
• Rotator Cuff/surgery
• Rotator Cuff Injuries/surgery

• clinical assessment/grading scales
• clinical outcomes
• hard anchor
• rotator cuff
• rotator cuff repair
• shoulder
• soft anchor

• Arthrex

• Computed tomography arthrography
• Patient satisfaction
• Retear
• Rotator cuff repair

• Enthesis
• gait
• healing
• insertion site
• rotator cuff
• supraspinatus
• surgical repair

• interscalene nerve block
• irrigation system
• patient position
• pneumothorax
• shoulder arthroscopy

• Male
• Female
• Humans
• Aged
• Middle Aged
• Arthroscopy/adverse effects
• Shoulder/surgery
• Pneumothorax/etiology
• Rotator Cuff Injuries/surgery
• Rotator Cuff Injuries/complications
• Brachial Plexus Block

Healing of the tendon itself is not always related to successful clinical outcomes after rotator cuff repair. It was hypothesized that certain radiologic factors affecting clinical outcomes could exist in case of the retear after arthroscopic rotator cuff repair (ARCR) and the radiologic factors could help predict clinical process. The purpose of this study was to identify the radiologic factors associated with clinical outcomes of the retear after ARCR.

Between January 2012 and December 2019, among patients with sufficient footprint coverage for ARCR, 96 patients with Sugaya classification 4 or higher retear on follow-up magnetic resonance imaging were included. The association between clinical outcomes such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion and radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance was analyzed.

Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. And at the last follow-up, they improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). In multiple linear regression analysis, the variance of the mediolateral dimension of tear had statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01).

In patients with the retear after ARCR, the variance in the mediolateral dimension of tear had significantly negative association with the clinical outcomes. This could be considered to be reference as relative criteria and needed more sample and mechanical study.

• Rotator cuff tear
• double row
• long-term outcomes
• risk factor
• rotator cuff repair
• transosseous equivalent

• Adult
• Aged
• Arthroscopy
• Follow-Up Studies
• Humans
• Magnetic Resonance Imaging
• Middle Aged
• Retrospective Studies
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/surgery
• Treatment Outcome

This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections for treatment of full-thickness rotator cuff tear (RCT).

Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 were enrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HA injection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery using the American Shoulder and Elbow Surgeons score, visual analog scale pain score , functional scores (pain visual analog scale, function visual analog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity.

Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05). However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than in group I (0%) (p=0.021).

Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thickness RCT.

• Atelocollagen
• Full-thickness tear
• Hyaluronic acid
• Rotator cuff
• Shoulder

Introduction: Rotator cuff tear with delamination is considered a risk factor for postoperative retear. The purpose of this study was to compare clinical outcomes between three repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and the combination of DLSB with modified Debyere-Patte (DLSB + DP). Methods: 53 shoulders of 52 patients who had massive rotator cuff tears with delamination were categorized into three groups: EMSB (18 shoulders), DLSB (24 shoulders), and DLSB + DP (11 shoulders). The mean postoperative follow-up period was 34.6 months. Pre- and postoperative evaluations included a range of motion (ROM), Constant scores, global fatty degeneration (GFDI), and tendon integrity according to Sugaya’s classification by magnetic resonance images (MRI). Results: In all groups, ROM significantly improved after the procedures. Mean constant scores significantly improved: from 45.5 to 77.4 after EMSB, from 45.5 to 87.6 after DLSB, and from 46.3 to 88.0 after DLSB + DP. Significant differences were noted in postoperative Constant scores (p = 0.018: DLSB vs. EMSB, and p = 0.045: DLSB + DP vs. EMSB). The Constant pain scores were better for DLSB + DP than for EMSB (p = 0.012). Global fatty degeneration index (GFDI) with DLSB + DP was significantly higher than that for either EMSB or DLSB, indicating significant preoperative fatty degeneration for DLSB + DP. Retear occurred in 27.8% of the EMSB group, 12.5% of the DLSB group, and 9.1% of the DLSB + DP group. Discussion: Comparisons of the three groups demonstrated that DLSB and DLSB + DP achieved better clinical outcomes than EMSB for the repair of large or massive rotator cuff tears. DLSB + DP is useful for massive rotator cuff tears with severe fatty degeneration or for cases where the presence of excessive tension is anticipated when repairing the torn cuff.

• Delamination
• Double-layer repair
• En masse repair
• Rotator cuff tear
• Suture-bridge

• American shoulder and elbow surgeons score
• Arthroscopic rotator cuff repair
• Ceiling effect
• Constant–Murley shoulder score
• Simple shoulder test
• University of California at Los Angeles shoulder rating scale

• arthroscopic shoulder surgery
• outcome scores
• rotator cuff tear
• transosseous repair

Biologic technologies can potentially augment existing arthroscopic rotator cuff repair to improve retear rates and postoperative outcomes. The purpose of this study was to evaluate healing rates and clinical outcomes of full-thickness rotator cuff repairs augmented with a bioinductive bovine collagen implant.

In this prospective multicenter study, investigators enrolled 115 patients (mean age, 60.4 years) with full-thickness rotator cuff tears. There were 66 (57.4%) medium (1-3 cm) tears and 49 (42.6%) large (3-5 cm) tears. Eligible patients consisted of those ≥21 years of age with chronic shoulder pain lasting longer than 3 months and unresponsive to conservative therapy. Patients underwent single- or double-row repair augmented with a bioinductive bovine collagen implant. At the baseline, 3 months, and 1 year, magnetic resonance imaging was performed and patients were assessed for American Shoulder and Elbow Surgeons (ASES) Shoulder Score and Constant-Murley Score (CMS). The primary failure end point was retear, classified as any new full-thickness defect observed on magnetic resonance imaging.

There were 13 retears (11.3%) at 3 months, with an additional 6 (19 total [16.5%]) found at 1 year. In large tears, double-row repair had a significantly lower rate of retear at 3 months (P = .0004) and 1 year (P = .0001) compared with single-row repair. ASES and CMS scores significantly improved between the baseline and 1 year for medium and large tears. At 1 year, the minimally clinically important difference for ASES and CMS was met by 91.7% (95% CI: 84.9-96.1) and 86.4% (95% CI: 78.2-92.4) of patients, respectively. Patients without retear and those <65 years of age had significantly better CMS scores at 1 year when compared with those with retear and those ≥65 years (P < .05). There was no statistically significant difference in outcomes based on treatment of the biceps tendon. Of 9 reported reoperations in the operative shoulder, only 2 were considered potentially related to the collagen implant.

Interim results from this prospective study indicate a favorable rate of retear relative to the literature and improvement in clinical function at 1 year after adjunctive treatment with the study implant augmenting standard arthroscopic repair techniques.

• ASES
• CMS
• Rotator cuff
• bioinductive
• clinical outcomes
• full-thickness
• implant
• retears

• Rotator cuff
• arthroscopy
• operative time
• shoulder
• sports medicine
• tendon repair

• Aged
• Arthroscopy
• Female
• Humans
• Male
• Middle Aged
• Operative Time
• Rotator Cuff Injuries/pathology
• Rotator Cuff Injuries/surgery
• Suture Techniques

• TL1 TR002382 NCATS NIH HHS
• UL1 TR002378 NCATS NIH HHS

The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair.

We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year.

The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies (Q = 209.53, I² = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate (P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195).

The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.

• Rotator cuff repair
• age
• meta-analysis
• rotator cuff repair failure
• shoulder
• systematic review

The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory.

Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force.

Controlled laboratory study.

A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing.

The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied (P = .15) and untied (P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor (P = .16) and double-loaded suture tape and anchor (P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied.

An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors.

Both tied and untied medial rows demonstrated similar pressures across the repair construct.

• double row
• medial row
• rotator cuff repair
• suture anchor
• suture tape

• Biomechanical study
• Medial row configuration
• Rotator cuff repair
• Suture bridge technique
• Type 2 retear

• Bone erosion
• Computed tomography
• Impingement
• Rotator cuff repair
• Suture knots
• Three-dimensional

• cuff integrity
• long-term follow-up
• mini-open cuff repair
• patient-reported outcome measures
• rotator cuff repair

• Collagen organization
• osteoclast
• rotator cuff healing
• tendon injury
• tendon-bone attachment

• Animals
• Biomechanical Phenomena
• Bone and Bones/pathology
• Cell Count
• Female
• Male
• Organ Size
• Rats, Sprague-Dawley
• Rotator Cuff/diagnostic imaging
• Rotator Cuff/pathology
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/pathology
• Wound Healing
• X-Ray Microtomography

• K12 HD073945 NICHD NIH HHS
• P20 RR016458 NCRR NIH HHS
• P20 GM103446 NIGMS NIH HHS
• P30 AR057235 NIAMS NIH HHS
• P30 GM103333 NIGMS NIH HHS
• NNX15AI19H NASA

• functional outcome
• integrity
• re-tear
• repair
• rotator cuff

• Rotator cuff
• acellular human dermal matrix
• allograft
• arthroscopy
• augmentation
• revision
• shoulder

• Bone morphogenetic protein
• histologic analysis
• infraspinatus tendon
• rotator cuff repair
• tendon-to-bone repair
• β-tricalcium phosphate

• Arthroplasty
• Bicepstenodesis
• Bicepstenotomy
• Debridement
• Fatty infiltration
• Partial repair
• Rotator cuff repair
• Rotator cuff tear

• Biologics
• Cytokines
• Patches
• Platelet-rich plasma
• Rotator cuff

• Biological augmentation
• Biomechanics
• Double row
• Growth factors
• Platelet-rich plasma

• Rotator cuff repair
• arthroscopy
• delayed motion
• early motion
• meta-analysis
• outcomes
• rehabilitation
• shoulder

• Arthroplasty
• Exercise Therapy
• Female
• Humans
• Male
• Middle Aged
• Range of Motion, Articular
• Recovery of Function
• Rotator Cuff Injuries/rehabilitation
• Rotator Cuff Injuries/surgery
• Treatment Outcome

• Modified tension band
• Retear rate
• Rotator cuff tear
• Suture bridge
• Tear size

How the use of the transosseous-equivalent (TOE) technique effects the stress concentration in repaired rotator cuff tendon is unknown. This study was conducted to determine the strain between the intact rotator cuff tendon and the tendon repaired using the TOE technique with and without medial row suture tying.

Strain of the infraspinatus tendon from 10 fresh-frozen cadavers was measured at the (A) tendon insertion, (B) tendon footprint, (C) tendon of the medial suture level, and (D) musculotendinous junction of the tendon. The strain was measured during 2 cycles of internal and external rotations while applying 4 different loads to the infraspinatus. After the intact tendon was evaluated, an artificially created tear of the infraspinatus was repaired using the TOE technique. Medial row sutures were tied in 5 shoulders (T group) and untied in the rest (UT group). The strains at 4 sites were compared between the intact and the TOE-repaired tendon and between the T and UT groups.

The strain was significantly reduced at site B in the repaired tendon in the T and UT groups compared with the intact tendon for all loads (P < .05). At site C, the strain increased for all loads in the T group compared with the intact tendon (P < .05).

The strain of the tendon over the footprint area was significantly smaller than the intact tendon when repaired with the TOE technique. The strain at the medial suture level was significantly greater when the medial sutures were tied compared with those untied.

• Cadaver
• Medial row
• Rotator cuff tear
• Strain
• Suture tying
• Transosseous-equivalent technique

• biology of tendon
• biomechanics of tendon
• muscle injuries
• rotator cuff
• shoulder

It is generally accepted that rotator cuff repair gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of structural failure or re-tear. The purpose of this review study is to assess whether failure of the repaired cuff to heal could negatively affect the functional outcome.

This article includes an extensive Internet PubMed based research in the current English-language literature including level I to level V studies as well as systematic reviews.

According to this extended study research, the results are mixed; certain reports show that patients with a healed rotator cuff repair have improved function and strength compared to those with structural failure, whereas other studies support the generally perceived concept that tendon re-tear does not lead to inferior clinical outcome.

Further high-level prospective studies with larger numbers of patients and longer follow up are needed to overcome the current debate over function between healed and failed rotator cuff repairs.

• Double-row repair
• Failed rotator cuff repair
• Single-row repair
• Structural failure
• Tendon healing

• Meta-analysis
• Prognosis
• Rotator cuff repair
• Rotator cuff tear

• Arthroscopic rotator cuff repair
• functional outcomes
• repair integrity
• retear rate
• suture bridge

• Arthroscopic transosseous rotator cuff repair
• rotator cuff tear
• shoulder arthroscopy
• suture anchors

• active range of motion
• healing
• rehabilitation
• rotator cuff

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

• Rotator cuff tears
• Partial thickness tears
• Full thickness tear
• Natural history
• Ultrasonography
• Magnetic resonance imaging
• Single row repair
• Double row repair
• Healing

The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique.

Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2^nd, 4^th, or 8^th week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8^th week.

The load to failure of the SB group was 134.59 ± 17.69 N at the 8^th postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4^th and 8^th weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally.

The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.

Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.

• Shoulder
• Repair
• Healing
• Tendon
• Rotator cuff tear

• biological healing enhancement
• prognostic factors
• rotator cuff
• shoulder

• Adipose Tissue/pathology
• Bone Cysts/pathology
• Bone Marrow/pathology
• Edema/pathology
• Humans
• Magnetic Resonance Imaging
• Muscular Atrophy/pathology
• Patient Outcome Assessment
• Postoperative Period
• Reproducibility of Results
• Rotator Cuff/pathology
• Rotator Cuff/surgery
• Rotator Cuff Injuries

• Appropriate Use Criteria (AUC)
• irreparable tears
• natural history
• recurrent tears
• rotator cuff tears

• outcome
• retear
• rotator cuff repair