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Rotator cuff pathology: state of the art
  1. Matthias A Zumstein1,
  2. Mike Künzler1,
  3. Taku Hatta2,
  4. Leesa M Galatz3,
  5. Eiji Itoi2
  1. 1 Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  2. 2 Leni & Peter May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York City, New York, USA
  3. 3 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
  1. Correspondence to Dr Eiji Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; itoi-eiji{at}


The rotator cuff tendon undergoes degeneration and tear quite commonly in the elderly population and was rarely observed in patients under 50 years of age. In addition to ageing, smoking, diabetes mellitus and other comorbidities are known to be the risk factors of tendon tear. Bony anatomy of the acromion relative to the glenoid plays a role on the onset of degenerative cuff tears. The biological responses of chronic tendinopathy, degenerative tear and the following muscle atrophy and fatty infiltration are regulated by macrophages. Age, tear size and chronicity have direct influence on healing after rotator cuff repair. Systematic reviews have shown that there is better healing in larger tears with a double row repair compared with a single row repair, but no differences in clinical outcome. The tendon healing is characterised by a fibrovascular scar response rather than by regenerating normal tendon tissue. As a result, the material and structural properties are much weaker than the normal tendon-to-bone interface. With this knowledge, better repair techniques and repair methods are expected to be developed for better healing of the tendon.

  • Rotator Cuff Tear
  • Pathology
  • Epidemiology
  • Critical Shoulder Angle
  • Tendon healing
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  • Contributors MAZ: author of the tendon pathology section. MK: author of the tendon pathology section. TH: author of the epidemiology section. LMG: author of the tendon healing section. EI: author of the epidemiology section, entire management and planning.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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