Background: The rate of retears after rotator cuff repair varies from 11% to 94%. A retear is associated with poorer subjective and objective clinical outcomes than intact repair. Purpose: This study was designed to determine which preoperative and/or intraoperative factors held the greatest association with retears after arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity. Exclusion criteria included previous rotator cuff repair on the same shoulder, incomplete repair, and repair using a synthetic polytetrafluoroethylene patch. All patients had completed the modified L’Insalata Questionnaire and underwent a clinical examination before surgery. Measurements of tear size, tear thickness, associated shoulder injury, tissue quality, and tendon mobility were recorded intraoperatively. Results: The overall retear rate at 6 months after surgery was 17%. Retears occurred in 27% of full-thickness tears and 5% of partial-thickness tears ( P < .0001). The best independent predictors of retears were anteroposterior tear length (correlation coefficient r = 0.41, P < .0001), tear size area ( r = 0.40, P < .0001), mediolateral tear length ( r = 0.34, P < .0001), tear thickness ( r = 0.29, P < .0001), age at surgery ( r = 0.27, P < .0001), and operative time ( r = 0.18, P < .0001). These factors produced a predictive model for retears: logit P = (0.039 × age at surgery in years) + (0.027 × tear thickness in %) + (1 × anteroposterior tear length in cm) + (0.76 × mediolateral tear length in cm) – (0.17 × tear size area in cm ² ) + (0.018 × operative time in minutes) –9.7. Logit P can be transformed into P, which is the chance of retears at 6 months after surgery. Conclusion: A rotator cuff retear is a multifactorial process with no single preoperative or intraoperative factor being overwhelmingly predictive of it. Nevertheless, rotator cuff tear size (tear dimensions, tear size area, and tear thickness) showed stronger associations with retears at 6 months after surgery than did measures of tissue quality and concomitant shoulder injuries.

Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the “dose” of load to the tendon enthesis – including increased activity, weight, advancing age, and genetic factors. The cells in tendinopathic tendon are rounder, more numerous, and show evidence of oxidative damage and more apoptosis. These cells also produce a matrix that is thicker and weaker with more water, more immature and cartilage-like matrix proteins, and less organization. There is now evidence of a population of regenerating stem cells within tendon. These studies suggest prevention of tendinopathy should be directed at reducing the volume of repetitive loads to below that which induces oxidative-induced apoptosis and cartilage-like genes. The management strategies might involve agents or cells that induce tendon stem cell proliferation, repair and restoration of matrix integrity.

Background: Porcine small intestine submucosal grafts have been successful in enhancing soft tissue repair, as demonstrated by animal studies. Currently, there are no reports of the use of such implants in human rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Over a 6-month period, 25 patients underwent rotator cuff repair by one surgeon using the Restore Orthobiologic Implant to augment the repaired tendon or fill a defect. Results: Four of 25 patients experienced an overt inflammatory reaction at a mean of 13 days postoperatively. All patients underwent open irrigation and debridement of the rotator cuff and porcine small intestine submucosal implant. Conclusion: Porcine small intestine submucosal implants should be used in rotator cuff surgery with the awareness that a non-specific inflammatory reaction can occur in the early postoperative period. This inflammatory reaction may cause breakdown of the repair. Further studies are needed to further characterize the reaction and determine which patients are susceptible.

Background: This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain.

Background: The prevalence of rotator cuff tears increases with age, and many patients undergo surgical repair. Retears are not uncommon, with rates ranging between 9% and 36% in recent studies, and are a major concern. The aim of this study was to investigate the relationship between patient age and the chance of healing following rotator cuff repair. Methods: This was a retrospective cohort study of patients who had undergone arthroscopic rotator cuff repair performed by a single surgeon. All patients had an ultrasound performed by a musculoskeletal sonographer 6 months after rotator cuff repair to assess the repair integrity. Results: The cohort of 1,600 patients was normally distributed in terms of age, with a mean age (and standard error of the mean) of 59 ± 0.3 years and a range of 15 to 91 years. The 212 patients (13%) who had a retear at 6 months were also normally distributed in terms of age, with a mean age of 65 ± 0.8 years and a range of 15 to 88 years. The retear rate in patients <50 years old was 5%. This increased to 10% in patients aged 50 to 59 years, 15% in those aged 60 to 69 years, 25% in those aged 70 to 79 years, and 34% in those aged ≥80 years. Multiple logistic regression analysis showed that patient age was an independent factor strongly associated with retears. Conclusions: The rate of rotator cuff retears is low in patients <50 years of age. The relationship between age and rotator cuff retears is linear in patients 50 to 69 years of age, with an increase of 5% between decades, and increases substantially in patients ≥70 years old. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.