Skip to main content
SpringerLink
Log in

Rotator cuff tears: pathology and repair

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others). In an era of emerging biologic interventions, our interventions are increasingly being modulated by our understanding of these core processes, many of which remain uncertain today. When we do intervene surgically, the techniques we employ are particularly challenging in the context of the tremendous pace of advancement. Several recent studies have shown that arthroscopic repair gives similar functional results to that of mini-open and open procedures, with all the benefits of minimally invasive surgery. However, the ‘best’ repair construct remains unknown, with wide variations in surgeon preference. Here we present a literature review encompassing recent developments in our understanding of basic science in rotator cuff disease as well as an up-to-date evidence-based comparison of different techniques available to the surgeon for cuff repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Abbi G, Espinoza L, Odell T, Mahar A, Pedowitz R (2006) Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy 22:38–43

    PubMed  Google Scholar 

  2. Amiel D, Akeson WH, Harwood FL, Mechanic GL (1980) The effect of immobilization on the types of collagen synthesized in periarticular connective tissue. Connect Tissue Res 8:27–32

    Article  PubMed  CAS  Google Scholar 

  3. Anderson K, Boothby M, Aschenbrener D, van Holsbeeck M (2006) Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up. Am J Sports Med 34:1899–1905

    Article  PubMed  Google Scholar 

  4. Badylak SF, Tullius R, Kokini K, Shelbourne KD, Klootwyk T, Voytik SL, Kraine MR, Simmons C (1995) The use of xenogeneic small intestinal submucosa as a biomaterial for Achilles tendon repair in a dog model. J Biomed Mater Res 29:977–985

    Article  PubMed  CAS  Google Scholar 

  5. Barber FA, Herbert MA, Coons DA (2006) Tendon augmentation grafts: biomechanical failure loads and failure patterns. Arthroscopy 22:534–538

    PubMed  Google Scholar 

  6. Barber FA, Herbert MA, Coons DA, Boothby MH (2006) Sutures and suture anchors—update 2006. Arthroscopy 22(10):1063.e1–1063.e9

    Google Scholar 

  7. Barber FA, Herbert MA, Richards DP (2003) Sutures and suture anchors: update 2003. Arthroscopy 19:985–990

    Article  PubMed  Google Scholar 

  8. Bardana DD, Burks RT, West JR, Greis PE (2003) The effect of suture anchor design and orientation on suture abrasion: an in vitro study. Arthroscopy 19:274–281

    PubMed  Google Scholar 

  9. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC (1991) The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 10:823–838

    PubMed  CAS  Google Scholar 

  10. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87:1229–1240

    Article  PubMed  Google Scholar 

  11. Brooks CH, Revell WJ, Heatley FW (1992) A quantitative histological study of the vascularity of the rotator cuff tendon. J Bone Joint Surg Br 74:151–153

    PubMed  CAS  Google Scholar 

  12. Burkhart SS (1995) The deadman theory of suture anchors: observations along a South Texas fence line. Arthroscopy 11:119–123

    PubMed  CAS  Google Scholar 

  13. Burkhart SS (2000) A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles. Arthroscopy 16:82–90

    PubMed  CAS  Google Scholar 

  14. Burkhart SS, Wirth MA, Simonich M, Salem D, Lanctot D, Athanasiou K (2000) Knot security in simple sliding knots and its relationship to rotator cuff repair: How secure must the knot be? Arthroscopy 16:202–207

    Article  PubMed  CAS  Google Scholar 

  15. Chen JM, Willers C, Xu J, Wang A, Zheng MH (2007) Autologous tenocyte therapy using porcine-derived bioscaffolds for massive rotator cuff defect in rabbits. Tissue Eng 13:1479–1491

    Article  PubMed  CAS  Google Scholar 

  16. Chhabra A, Goradia VK, Francke EI, Baer GS, Monahan T, Kline AJ, Miller MD (2005) In vitro analysis of rotator cuff repairs: a comparison of arthroscopically inserted tacks or anchors with open transosseous repairs. Arthroscopy 21:323–327

    Article  PubMed  Google Scholar 

  17. Chow JC, Gu Y (2004) Material reaction to suture anchor. Arthroscopy 20:314–316

    Article  PubMed  Google Scholar 

  18. Coghlan J, Buchbinder R, Green S, Johnston R, Bell S (2008) Surgery for rotator cuff disease. Cochrane Database Syst Rev 23(1):CD005619

    Google Scholar 

  19. De Carli A, Vadala A, Monaco E, Labianca L, Zanzotto E, Ferretti A (2005) Effect of cyclic loading on new polyblend suture coupled with different anchors. Am J Sports Med 33:214–219

    Article  PubMed  Google Scholar 

  20. Deakin M, Stubbs D, Bruce W, Goldberg J, Gillies RM, Walsh WR (2005) Suture strength and angle of load application in a suture anchor eyelet. Arthroscopy 21:1447–1451

    Article  PubMed  Google Scholar 

  21. Dejardin LM, Arnoczky SP, Ewers BJ, Haut RC, Clarke RB (2001) Tissue-engineered rotator cuff tendon using porcine small intestine submucosa. Am J Sports Med 29:175–184

    PubMed  CAS  Google Scholar 

  22. Dejong ES, DeBerardino TM, Brooks DE, Judson K (2004) In vivo comparison of a metal versus a biodegradable suture anchor. Arthroscopy 20:511–516

    PubMed  Google Scholar 

  23. Demirhan M, Kilicoglu O, Akpinar S, Akman S, Atalar AC, Goksan MA (2000) Time-dependent reduction in load to failure of wedge-type polyglyconate suture anchors. Arthroscopy 16:383–390

    Article  PubMed  CAS  Google Scholar 

  24. Dinnes J, Loveman E, McIntyre L, Waugh N (2003) The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess 7(29):iii, 1–166

    Google Scholar 

  25. Droge W (2003) Oxidative stress and aging. Adv Exp Med Biol 543:191–200

    PubMed  CAS  Google Scholar 

  26. Ertl JP, Kovacs G, Burger RS (1998) Magnetic resonance imaging of the shoulder in the primary care setting. Med Sci Sports Exerc 30:7–11

    Google Scholar 

  27. Favard L, Bacle G, Berhouet J (2007) Rotator cuff repair. Joint Bone Spine 74:551–557

    Article  PubMed  Google Scholar 

  28. Fealy S, Adler RS, Drakos MC, Kelly AM, Allen AA, Cordasco FA, Warren RF, O’Brien SJ (2006) Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med 34:120–127

    Article  PubMed  Google Scholar 

  29. Filomeni G, Aquilano K, Civitareale P, Rotilio G, Ciriolo MR (2005) Activation of c-Jun-N-terminal kinase is required for apoptosis triggered by glutathione disulfide in neuroblastoma cells. Free Radic Biol Med 39:345–354

    Article  PubMed  CAS  Google Scholar 

  30. Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V (2007) Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 35:1254–1260

    Article  PubMed  Google Scholar 

  31. Fukuda H, Hamada K, Yamanaka K (1990) Pathology and pathogenesis of bursal-side rotator cuff tears viewed from en bloc histologic sections. Clin Orthop Relat Res 254:75–80

    PubMed  Google Scholar 

  32. Galatz LM, Silva MJ, Rothermich SY, Zaegel MA, Havlioglu N, Thomopoulos S (2006) Nicotine delays tendon-to-bone healing in a rat shoulder model. J Bone Joint Surg Am 88:2027–2034

    Article  PubMed  CAS  Google Scholar 

  33. Gerber C, Schneeberger AG, Hoppeler H, Meyer DC (2007) Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elbow Surg 16:691–696

    Article  PubMed  Google Scholar 

  34. Gotoh M, Hamada K, Yamakawa H, Tomonaga A, Inoue A, Fukuda H (1997) Significance of granulation tissue in torn supraspinatus insertions: an immunohistochemical study with antibodies against interleukin-1 beta, cathepsin D, and matrix metalloprotease-1. J Orthop Res 15:33–39

    Article  PubMed  CAS  Google Scholar 

  35. Gotoh M, Hamada K, Yamakawa H, Yanagisawa K, Nakamura M, Yamazaki H, Inoue A, Fukuda H (2002) Interleukin-1-induced glenohumeral synovitis and shoulder pain in rotator cuff diseases. J Orthop Res 20:1365–1371

    Article  PubMed  CAS  Google Scholar 

  36. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    PubMed  Google Scholar 

  37. Goutallier D, Postel JM, Van Driessche S, Voisin MC (2005) Histological lesions of supraspinatus tendons in full thickness tears of the rotator cuff. Rev Chir Orthop Reparatrice Appar Mot 91:109–113

    PubMed  CAS  Google Scholar 

  38. Han Z, Boyle DL, Chang L, Bennett B, Karin M, Yang L, Manning AM, Firestein GS (2001) c-Jun N-terminal kinase is required for metalloproteinase expression and joint destruction in inflammatory arthritis. J Clin Invest 108:73–81

    PubMed  CAS  Google Scholar 

  39. Harryman DT 2nd, Hettrich CM, Smith KL, Campbell B, Sidles JA, Matsen FA 3rd (2003) A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status. J Bone Joint Surg Am 85:690–696

    PubMed  Google Scholar 

  40. Hashimoto T, Nobuhara K, Hamada T (2003) Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res 415:111–120

    Article  PubMed  Google Scholar 

  41. Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF (2007) Arthroscopic rotator cuff repair with double-row fixation. J Bone Joint Surg Am 89:1248–1257

    Article  PubMed  Google Scholar 

  42. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ (2006) Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am 88:1238–1244

    Article  PubMed  Google Scholar 

  43. Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525

    PubMed  CAS  Google Scholar 

  44. Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ (2005) Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med 33:208–213

    Article  PubMed  Google Scholar 

  45. Kilicoglu O, Demirhan M, Akman S, Atalar AC, Ozsoy S, Ince U (2003) Failure strength of bioabsorbable interference screws: effects of in vivo degradation for 12 weeks. Knee Surg Sports Traumatol Arthrosc 11:228–234

    Article  PubMed  Google Scholar 

  46. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34:407–414

    Article  PubMed  CAS  Google Scholar 

  47. Koganti AK, Adamson GJ, Gregersen CS, Pink MM, Shankwiler JA (2006) Biomechanical comparison of traditional and locked suture configurations for arthroscopic repairs of the rotator cuff. Am J Sports Med 34:1832–1838

    Article  PubMed  Google Scholar 

  48. Kumagai J, Sarkar K, Uhthoff HK (1994) The collagen types in the attachment zone of rotator cuff tendons in the elderly: an immunohistochemical study. J Rheumatol 21:2096–2100

    PubMed  CAS  Google Scholar 

  49. Lafosse L, Brozska R, Toussaint B, Gobezie R (2007) The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 89:1533–1541

    Article  PubMed  Google Scholar 

  50. Lichtenberg S, Liem D, Magosch P, Habermeyer P (2006) Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason–Allen suture technique: a prospective, MRI controlled study. Knee Surg Sports Traumatol Arthrosc 14:1200–1206

    Article  PubMed  Google Scholar 

  51. Liporace FA, Bono CM, Caruso SA, Weiner B, Penny K, Feldman AJ, Grossman MG, Haher TR (2002) The mechanical effects of suture anchor insertion angle for rotator cuff repair. Orthopedics 25:399–402

    PubMed  Google Scholar 

  52. Lo IK, Burkhart SS, Athanasiou K (2004) Abrasion resistance of two types of nonabsorbable braided suture. Arthroscopy 20:407–413

    Article  PubMed  Google Scholar 

  53. Lo IK, Burkhart SS, Chan KC, Athanasiou K (2004) Arthroscopic knots: determining the optimal balance of loop security and knot security. Arthroscopy 20:489–502

    Article  PubMed  Google Scholar 

  54. Lohr JF, Uhthoff HK (1990) The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res 254:35–38

    PubMed  Google Scholar 

  55. Loutzenheiser TD, Harryman DTI, Ziegler DW, Yung SW (1998) Optimizing arthroscopic knots using braided or monofilament suture. Arthroscopy 14:57–65

    Article  PubMed  CAS  Google Scholar 

  56. Ma CB, Comerford L, Wilson J, Puttlitz CM (2006) Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 88:403–410

    Article  PubMed  Google Scholar 

  57. Ma CB, MacGillivray JD, Clabeaux J, Lee S, Otis JC (2004) Biomechanical evaluation of arthroscopic rotator cuff stitches. J Bone Joint Surg Am 86:1211–1216

    PubMed  Google Scholar 

  58. Mahar AT, Tucker BS, Upasani VV, Oka RS, Pedowitz RA (2005) Increasing the insertion depth of suture anchors for rotator cuff repair does not improve biomechanical stability. J Shoulder Elbow Surg 14:626–630

    Article  PubMed  Google Scholar 

  59. Malcarney HL, Bonar F, Murrell GA (2005) Early inflammatory reaction after rotator cuff repair with a porcine small intestine submucosal implant: a report of 4 cases. Am J Sports Med 33:907–911

    Article  PubMed  Google Scholar 

  60. Mallon WJ, Misamore G, Snead DS, Denton P (2004) The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg 13:129–132

    Article  PubMed  Google Scholar 

  61. Matsen FA 3rd (1998) The rotator cuff. In: Rockwood CA Jr, Matsen FA 3rd (eds) The shoulder, chap 15. W. B. Saunders, Philadelphia, pp 755–839

  62. Matsen FA 3rd (2008) Clinical practice. Rotator-cuff failure. N Engl J Med 358:2138–2147

    Article  PubMed  CAS  Google Scholar 

  63. Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA (2005) Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 33:1861–1868

    Article  PubMed  Google Scholar 

  64. Moseley HF, Goldie I (1963) The arterial pattern of the rotator cuff of the shoulder. J Bone Joint Surg Br 45:780–789

    PubMed  CAS  Google Scholar 

  65. Neer CS II, Poppen NK (1987) Supraspinatus outlet. Orthop Trans 11:234

    Google Scholar 

  66. Nicholson GP, Goodman DA, Flatow EL, Bigliani LU (1996) The acromion: morphologic condition and age-related changes. A study of 420 scapulas. J Shoulder Elbow Surg 5:1–11

    Article  PubMed  CAS  Google Scholar 

  67. Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS (2005) Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med 33:1154–1159

    Article  PubMed  Google Scholar 

  68. Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ (2007) Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 16:461–468

    Article  PubMed  Google Scholar 

  69. Rees JD, Wilson AM, Wolman RL (2006) Current concepts in the management of tendon disorders. Rheumatology (Oxford) 45:508–521

    Article  CAS  Google Scholar 

  70. Riley GP, Harrall RL, Constant CR, Chard MD, Cawston TE, Hazleman BL (1994) Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis. Ann Rheum Dis 53:359–366

    Article  PubMed  CAS  Google Scholar 

  71. Rokito AS, Cuomo F, Gallagher MA, Zuckerman JD (1999) Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff. J Bone Joint Surg Am 81:991–997

    Article  PubMed  CAS  Google Scholar 

  72. Rutten MJ, Maresch BJ, Jager GJ, Blickman JG, van Holsbeeck MT (2007) Ultrasound of the rotator cuff with MRI and anatomic correlation. Eur J Radiol 62:427–436

    Article  PubMed  Google Scholar 

  73. Sahin G, Demirtas M (2006) An overview of MR arthrography with emphasis on the current technique and applicational hints and tips. Eur J Radiol 58:416–430

    Article  PubMed  Google Scholar 

  74. Schlegel TF, Hawkins RJ, Lewis CW, Motta T, Turner AS (2006) The effects of augmentation with Swine small intestine submucosa on tendon healing under tension: histologic and mechanical evaluations in sheep. Am J Sports Med 34:275–280

    Article  PubMed  Google Scholar 

  75. Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C (2002) Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am 84-A:2152–2160

    PubMed  Google Scholar 

  76. Skutek M, van Griensven M, Zeichen J, Brauer N, Bosch U (2003) Cyclic mechanical stretching of human patellar tendon fibroblasts: activation of JNK and modulation of apoptosis. Knee Surg Sports Traumatol Arthrosc 11:122–129

    PubMed  Google Scholar 

  77. Soslowsky LJ, Thomopoulos S, Tun S, Flanagan CL, Keefer CC, Mastaw J, Carpenter JE (2000) Neer Award 1999. Overuse activity injures the supraspinatus tendon in an animal model: a histologic and biomechanical study. J Shoulder Elbow Surg 9:79–84

    Article  PubMed  CAS  Google Scholar 

  78. Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 21:1307–1316

    Article  PubMed  Google Scholar 

  79. Swiontkowski MF, Iannotti JP, Boulas HJ, Esterhai JL (1990) Intraoperative assessment of rotator cuff vascularity using laser Doppler flowmetry. In: Post M, Morrey BF, Hawkins RJ (eds) Surgery of the shoulder, pp 208–212, 208–212. Mosby, St. Louis

  80. Tempelhof S, Rupp S, Seil R (1999) Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 8:296–299

    Article  PubMed  CAS  Google Scholar 

  81. Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ (2004) Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality? Am J Sports Med 32:1466–1473

    Article  PubMed  Google Scholar 

  82. Tingart MJ, Apreleva M, Zurakowski D, Warner JJ (2003) Pullout strength of suture anchors used in rotator cuff repair. J Bone Joint Surg Am 85:2190–2198

    Article  PubMed  Google Scholar 

  83. Tsuzaki M, Guyton G, Garrett W, Archambault JM, Herzog W, Almekinders L, Bynum D, Yang X, Banes AJ (2003) IL-1 beta induces COX2, MMP-1, -3 and -13, ADAMTS-4, IL-1 beta and IL-6 in human tendon cells. J Orthop Res 21:256–264

    Article  PubMed  CAS  Google Scholar 

  84. Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y (2005) Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 33:1869–1874

    Article  PubMed  Google Scholar 

  85. Uggen JC, Dines J, Uggen CW, Mason JS, Razzano P, Dines D, Grande DA (2005) Tendon gene therapy modulates the local repair environment in the shoulder. J Am Osteopath Assoc 105:20–21

    PubMed  Google Scholar 

  86. Uhthoff HK, Kumagi J, Sarkar K (1992) Morphologic evidence of healing in torn human rotator cuffs. J Bone Joint Surg 74B(suppl 3):293–294

    Google Scholar 

  87. Verma NN, Dunn W, Adler RS, Cordasco FA, Allen A, MacGillivray J, Craig E, Warren RF, Altchek DW (2006) All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy 22:587–594

    Article  PubMed  Google Scholar 

  88. Walch G, Marechal E, Maupas J, Liotard JP (1992) Surgical treatment of rotator cuff rupture. Prognostic factors. Rev Chir Orthop Reparatrice Appar Mot 78:379–388

    PubMed  CAS  Google Scholar 

  89. Wang JC, Horner G, Brown ED, Shapiro MS (2000) The relationship between acromial morphology and conservative treatment of patients with impingement syndrome. Orthopedics 23:557–559

    PubMed  CAS  Google Scholar 

  90. Wang JC, Shapiro MS (1997) Changes in acromial morphology with age. J Shoulder Elbow Surg 6:55–59

    Article  PubMed  CAS  Google Scholar 

  91. White CD, Bunker TD, Hooper RM (2006) The strength of suture configurations in arthroscopic rotator cuff repair. Arthroscopy 22:837–841

    Article  PubMed  Google Scholar 

  92. Williams GR Jr, Rockwood CA Jr, Bigliani LU, Iannotti JP, Stanwood W (2004) Rotator cuff tears: why do we repair them? J Bone Joint Surg Am 86:2764–2776

    PubMed  Google Scholar 

  93. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA (2006) The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 88:1699–1704

    Article  PubMed  Google Scholar 

  94. Yuan J, Murrell GA, Trickett A, Landtmeters M, Knoops B, Wang MX (2004) Overexpression of antioxidant enzyme peroxiredoxin 5 protects human tendon cells against apoptosis and loss of cellular function during oxidative stress. Biochim Biophys Acta 1693:37–45

    Article  PubMed  CAS  Google Scholar 

  95. Yuan J, Murrell GA, Wei AQ, Wang MX (2002) Apoptosis in rotator cuff tendonopathy. J Orthop Res 20:1372–1379

    Article  PubMed  Google Scholar 

  96. Zalavras CG, Gardocki R, Huang E, Stevanovic M, Hedman T, Tibone J (2006) Reconstruction of large rotator cuff tendon defects with porcine small intestinal submucosa in an animal model. J Shoulder Elbow Surg 15:224–231

    Article  PubMed  Google Scholar 

  97. Zheng MH, Chen J, Kirilak Y, Willers C, Xu J, Wood D (2005) Porcine small intestine submucosa (SIS) is not an acellular collagenous matrix and contains porcine DNA: possible implications in human implantation. J Biomed Mater Res B Appl Biomater 73:61–67

    PubMed  CAS  Google Scholar 

  98. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C (2007) Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am 89:1928–1934

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

No outside funding or grant(s) were obtained for the present study.

Conflict of interest statement

One of the authors (JDM) serves as a consultant for Arthrex, Inc. (Naples, FL).

Author information

Authors and Affiliations

  1. The Hospital for Special Surgery, Office of Dr. John MacGillivray, Cornell University, East River Professional Building, 523 East 72nd Street, New York, NY, 10021, USA

    Hemang Yadav & John D. MacGillivray

  2. Section of Sports Medicine, Rush University Medical Centre, Chicago, IL, 60612, USA

    Shane Nho & Anthony Romeo

Authors
  1. Hemang Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shane Nho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony Romeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John D. MacGillivray
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hemang Yadav.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yadav, H., Nho, S., Romeo, A. et al. Rotator cuff tears: pathology and repair. Knee Surg Sports Traumatol Arthrosc 17, 409–421 (2009). https://doi.org/10.1007/s00167-008-0686-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-008-0686-8

Keywords

Search

Navigation