Clinical Trials Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2025; 16(6): 106458
Published online Jun 18, 2025. doi: 10.5312/wjo.v16.i6.106458
Rotator cuff and capsule healing after shoulder arthroscopy: A second look arthroscopic study
Christos Yiannakopoulos, Christos Koukos, Apostolos Habipis, Constantinos Apostolou
Christos Yiannakopoulos, School of Physical Education and Sport Science, National and Kapodistrian University, Athens 17237, Attikí, Greece
Christos Yiannakopoulos, Christos Koukos, Apostolos Habipis, Department of Orthopaedic, IASO Hospital, Athens 15123, Attikí, Greece
Constantinos Apostolou, Department of Orthopaedic, Evangelismos Hospital, Athens 10676, Attikí, Greece
Author contributions: Yiannakopoulos C developed the main idea, performed all surgeries and provided critical feedback; Koukos C and Habipis A reviewed all patient files and analyzed the data; Koukos C and Apostolou C wrote the first draft and performed all revisions; all authors have read and approved the final manuscript.
Institutional review board statement: Approved by the local Institutional Review Board Committee.
Clinical trial registration statement: Registered with the National and Kapodistrian University, Athens, Greece.
Informed consent statement: The participants have signed the informed consent.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data are available by contacting the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christos Yiannakopoulos, MD, PhD, Assistant Professor, School of Physical Education and Sport Science, National and Kapodistrian University, 41 Ethnikis Antistasis Street, Athens 17237, Attikí, Greece. c.yiannakopoulos@phed.uoa.gr
Received: February 28, 2025
Revised: April 2, 2025
Accepted: May 24, 2025
Published online: June 18, 2025
Processing time: 111 Days and 19.5 Hours
Abstract
BACKGROUND

Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears. The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site. Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.

AIM

To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.

METHODS

In this study, 24 adult patients with rotator cuff tears (13 patients) or anterior shoulder instability (11 patients) were included. All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology. The second operation was performed in 8 patients due to mild but persistent pain or stiffness, in 3 patients for recalcitrant stiffness, in 5 patients for secondary biceps tenotomy, in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding. Soft tissue healing was evaluated visually and by probing, whereas clinical outcomes were evaluated using the University of California–Los Angeles (UCLA) and Rowe rating scales.

RESULTS

In almost all patients, complete soft tissue healing occurred at the site of tissue reattachment, either on the glenoid articular surface or the greater humeral tuberosity. The strongest repair, as confirmed by probe palpation, was encountered at the site of suture passage through the soft tissue. All suture material was covered with bursal synovial tissue, with no cases of knot impingement or cartilage fraying. The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354 ± 3205 and 2931 ± 2898, respectively (P < 0.001), whereas for shoulder instability patients, the mean Rowe scores preoperatively and postoperatively were 2591 ± 1338 and 9272 ± 754, respectively (P < 0.001). The use of bioabsorbable implants did not cause synovitis or other tissue reactions.

CONCLUSION

Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.

Keywords: Arthroscopy; Instability; Rotator cuff; Shoulder; Soft tissue healing; Tendon

Core Tip: This is the first paper describing the macroscopic appearance of soft tissue healing in the shoulder using shoulder arthroscopy. A series of patients who had had shoulder arthroscopy for instability or rotator cuff tear were subjected to second look arthroscopy. The macroscopic findings of the study are described.