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Advances in the Repair and Rehabilitation of Shoulder Rotator Cuff Tears

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Dear Colleagues,

Rotator cuff tears are the most common shoulder problem, and their prevalence ranges from 5 to 30%. The majority of these cuff tears are degenerative, so their prevalence increases with age. Most degenerative tears are asymptomatic, but some develop pain. Still debated is the role of the association between the number of tendons involved, comorbidity factors, severity of the injury, humeral head migration, and fatty degeneration of the supraspinatus as a cause of painful evolution. The indications for surgery in rotator cuff tears are persistence of symptoms like pain after rehabilitation, traumatic full-thickness tear, good muscle quality as in younger individuals, and pseudoparalysis. While adopting for surgical intervention, all sources of pain should be considered. The sources of pain are cuff tear, subacromial bursa, biceps tendon attachment, a tight capsule, degenerative symptomatic acromioclavicular joint, and a tight subacromial space with hooked acromion, so the surgery should address all these potential pain-generating pathologies. The objective of rotator cuff repair is to achieve anatomical reduction of the cuff tear to the foot print. The age of the patient, duration of tear, extent of tear, and quality of tendon dictate the healing potential of the repaired cuff. The goal of the treatment is to achieve pain-free shoulders with good function. The outcome of repair is good in anatomical foot print repair.

Dr. Raffaello Pellegrino
Dr. Angelo Di Iorio
Dr. Giovanni Di Giacomo
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12 pages, 778 KiB

Open AccessArticle

Comparison of All-Suture Anchors and Metal Anchors in Arthroscopic Rotator Cuff Repair: Short-Term Clinical Outcomes and Anchor Pullout Risk

by Tolga Keçeci, Yusuf Polat, Abdullah Alper Şahin, Murat Alparslan, Serkan Sipahioğlu and Alper Çıraklı

J. Clin. Med. 2025, 14(8), 2619; https://doi.org/10.3390/jcm14082619 - 11 Apr 2025

Viewed by 365

Abstract

Objectives: Metal anchors (MA), commonly used in the early stages of rotator cuff surgical treatment development, are associated with a high risk of complications, especially in osteoporotic bone. As an alternative to rigid anchors, all-suture anchors (ASA) have been introduced for the medial row, offering promising clinical outcomes and favorable biomechanical studies. We aimed to compare the clinical outcomes of MAs and ASAs in either single-row or in medial-row suture bridge techniques in arthroscopic rotator cuff repair. Our hypothesis was that in cases where ASA was used for at least 12 months of follow-up, more favorable results would be obtained as compared to rigid anchors, and intraoperative complications such as anchor pullout would be encountered less. Methods: In this retrospective cohort analysis, we reviewed patients who underwent arthroscopic rotator cuff repair between January 2020 and December 2022. Surgeries were performed by two senior surgeons in a single tertiary center. Patients who had undergone revision surgery, had a history of previous shoulder surgeries, had massive rotator cuff tears, and partial-thickness tears; or had concomitant subscapularis tears were excluded. Preoperative and postoperative scores, including Constant–Murley (CM), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale (VAS), were compared. The minimum follow-up period was 12 months. Clinical assessment of shoulder range of motion included forward flexion, abduction, internal rotation, and external rotation. Intraoperative anchor-related complications were compared. All patients underwent the same surgical technique and postoperative rehabilitation protocol. Results: A total of 142 patients (89 females, 53 males; mean age: 57.4 years) were included in the study, with 67 patients in the ASA group and 75 in the MA group. The sex distribution and mean age were similar between groups. The ASA group had 15 traumatic tears, while the MA group had 13 (p < 0.05). The mean follow-up period was 21.6 months (range 12–40 months). Preoperative CM scores were statistically better in the ASA group, but this difference was not clinically relevant (p < 0.046). The mean CM score was 75.64, the mean DASH score was 8.57, and the mean VAS was 1.38 at the postoperative period in the MA group. The mean CM score was 78.40, the mean DASH score was 9.75, and VAS was 1.59 at the postoperative period in the ASA group. Seven cases experienced anchor pullout in the MA group, and thread breakage occurred in one patient of each group (p = 0.014). The mean age of the patients with anchor pullout was significantly higher (p = 0.002). This finding was not hypothesized in the initial study design but emerged during post-hoc analysis and highlights the importance of considering bone quality in elderly patients. Conclusions: The clinical outcomes of rotator cuff repairs using all-suture anchors or metal anchors are comparable. However, ASA use may offer an advantage in elderly patients by reducing the risk of anchor pullout. Further studies assessing tendon integrity and bone quality and incorporating long-term follow-up periods are recommended to support and validate the present findings. Full article

(This article belongs to the Special Issue Advances in the Repair and Rehabilitation of Shoulder Rotator Cuff Tears)

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