Table 2: Clinical studies showing better results in patients with healed rotator cuff repair compared to structurally failed repair.

Author Year Level of evidence Sample Follow-up Technique Outcomes Conclusion
Vastamäki et al. [46] 2013 Level IV, therapeutic study 67 patients
Mean age 52 years
Minimum 16 years
Range 16-25 years
Open repair MR arthrography 1) Re-tear rate 94%, Mean size of re-rupture (3,5x3,6cm)
2) 6% partial tear of supraspinatus
3) Fatty infiltration in supraspinatus and infraspinatus tendons
4) Active external rotation and forward flexion, strength of flexion, abduction and external rotation were better in patients with intact rotator cuff or small re-tear <4cm
5) Cuff integrity correlated with functional results several years postoperatively
Park et al. [47] 2013 Retrospective level IV study 36 patients with massive tear 37,6 +/- 8,9 months Arthroscopic suture bridge repair US (4.5, 12 and 24 months postoperative)
ASES, ROM, Constant and muscle power
1) 25% recurrent tear, 75% complete healing
2) All functional scores improved, but the re-tear group (especially with large size) had poorer outcome than healed group (ASES P=0.005, Constant P=0.175)
3) Fatty degeneration of supraspinatus preoperatively associated with high re-tear rate
Zumstein et al. [45] 2008 - 27 patients with massive tear 9.9 years Open repair Constant score
Radiographs and MRI
1) Re-tear rate 57% at 9.9 years and 37% at 3.1 years
2) Patients with an intact repair had better absolute and relative Constant score and abduction strength than those with failed reconstruction
3) Re-tear size increased from the initial
4) Supraspinatus and infraspinatus muscle fatty infiltration increased
5) Acromion index higher in re-tear group than intact group
Yoo et al. [3] 2013 Level III cohort study 81 patients 29.7 months - SF-36 scores, UCLA, ASES 1) 56/81 in healed group
25/81 in re-tear group
2) Clinical scores were significantly improved in both groups but significantly higher in the healed group
Kim et al. [49] 2014 cohort 180 patients At least 1 year - US
ASES, SST
1) Clinical scores significantly poorer in the re-tear group (p<0,05)
2) Patients with a re-tear, non-anatomic factors including younger age, lower educational level and heavy workers were associated with poorer outcomes
Lafosse et al. [50] 2007 - 105 patients - Arthroscopic double-row repair MRI arthrography, CT
Constant score, muscle strength, ROM
1) Superior clinical outcome in patients with healed repairs but not statistically significant
2) Pain relief in healed group (statistically significant p=0,014)

ASES: American Shoulder and Elbow Surgeons, CT: computed tomography, MRI: magnetic resonance imaging, ROM: range of motion, SST: simple shoulder test, UCLA: University of California at Los Angeles, US: ultrasound