Healing of the Rotator Cuff Tendon

Abstract

Rotator cuff injuries are one of the most common musculoskeletal complaints and affect a significant number of patients, particularly in the aging population. Rotator cuff tears are present in approximately 13% of patients in their 50s, 25% of patients in their 60s, and 50% of patients in their 80s (Tempelhof et al., J Shoulder Elbow Surg 8(4):296–299, 1999). Surgical treatment with rotator cuff repair is often indicated after failure of conservative treatment in patients with symptomatic rotator cuff tears, but a high rate of failure of healing has been reported in the literature (Galatz et al., J Bone Joint Surg Am 86-A(2):219–224, 2004; Miller et al., Am J Sports Med 39(10):2064–2070, 2011). While patients may improve after surgery even with recurrent rotator cuff tears in regard to decreased pain and increased function, the durability of outcomes after re-tear can be limited (Galatz et al., J Bone Joint Surg Am 86-A(2):219–224, 2004), and there is literature to suggest that an intact repair results in superior clinical outcomes (Miller et al., Am J Sports Med 39(10):2064–2070, 2011; Franceschi et al., Am J Sports Med 35(8):1254–1260, 2007; Harryman et al., J Bone Joint Surg Am 73(7):982–989, 1991; Nho et al., Am J Sports Med 37(10):1938–1945, 2009; Gazielly et al., Clin Orthop Relat Res (304):43–53, 1994; Zumstein et al., J Bone Joint Surg Am 90(11):2423–2431, 2008; Wylie et al., Orthop J Sports Med 6(1):2325967117750104, 2018). Tendon-to-bone healing in rotator cuff repair is a multifactorial process that is affected by patient-specific characteristics, intraoperative factors, and postoperative management. This chapter will discuss the normal rotator cuff tendon anatomy and healing response to injury, as well as the various factors that affect rotator cuff tendon healing.