Revision rotator cuff repair

Overview

Patients undergoing revision rotator cuff repair face a significantly elevated risk of failure, being twice as likely to experience a re-tear compared to primary repair candidates by two years postoperatively [1]. The primary indication for this procedure is the persistence of clinical symptoms despite nonsurgical management, provided there are no substantial risk factors for failure [2]. While arthroscopic revision offers a reasonable treatment option even after prior open repairs—yielding improved pain relief and shoulder function [6]—the overall outcomes remain inferior to those of primary repair, despite providing significant improvements in both pain and function at five years [3].

Long-term evaluation is critical, as one-year follow-up is not the definitive endpoint for assessing rotator cuff repair outcomes [20]. Although the two-year benchmark is widely accepted, it may be arbitrary and lacks clinical relevance, with one-year follow-up appearing sufficient for clinical decision-making [80]. Furthermore, while initial reports suggest graft augmentation could significantly alter treatment approaches for arthroscopic rotator cuff repair [5], combined acromioplasty and rotator cuff repair offer no significant long-term benefits in patient-reported outcomes or secondary surgery rates compared to arthroscopic repair alone [84]. Differences in complications between open and arthroscopic techniques may also be influenced by selection bias and narrowing indications for open repair [83].

Anatomy & Pathophysiology

Osseous and Joint Geometry: The biomechanical shoulder model aligns with clinical observations regarding glenoid inclination and acromion index effects on humeral head translation and glenoid articular cartilage strain [23]. Older asymptomatic males exhibit altered glenohumeral and scapulothoracic motion patterns compared to younger males during dynamic tasks [35].

Kinematics and Scapular Function: Optimal scapular function is a key component of all shoulder function, and alterations in scapular motion are associated with most types of shoulder pathology [26]. Observed changes in scapular kinematics after rotator cuff repair are associated with an increased overall range of motion and suggest restored function of shoulder muscles [25]. Alterations of scapular kinematics in symptomatic subjects are multifactorial [28]. Reverse total shoulder arthroplasty (RTSA) shoulders show kinematics that are significantly different from normal shoulders, using more scapulothoracic motion and less glenohumeral motion to elevate the arm [34]. The 3D glenohumeral kinematics at the early phase of arm elevation may affect the shoulder function in patients with massive rotator cuff tears [42].

Rotator Cuff and Cable Biomechanics: Tears of the posterior rotator cuff cable lead to altered glenohumeral biomechanics and kinematics in a cadaveric shoulder model of the throwing shoulder [29]. Tears of the subscapularis have greater biomechanical consequences than do tears of the infraspinatus [37]. Simulated anterosuperior rotator cuff tears involving the superior half of the subscapularis significantly alter shoulder biomechanics and lead to increased anterosuperior and superior glenohumeral translation under higher loads [40]. Findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology [33].

Biceps and Ligamentous Stability: Loading the long head of the biceps (LHB) and short head of the biceps (SHB) has significant effects on glenohumeral kinematics and contact characteristics in the throwing shoulder [27]. Anterior-posterior (A-P) glenohumeral kinematics was not fully restored after biceps rerouting (BR) [41]. While each coracoclavicular, acromioclavicular, or combined reconstruction technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its pre-injured state [38]. The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder [24].

Reconstruction and Transfer Outcomes: In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels [30]. In a dynamic shoulder model, performing superior capsular reconstruction (SCR) only partially restored native glenohumeral joint loads [31, 32, 36]. The goal of tendon transfers for massive rotator cuff tears is to achieve stable kinematics by restoring rotational strength and force coupling of the shoulder joint [39].

Classification

Hamada: This scheme employs a mechanistic approach to explain radiographic changes associated with chronic massive rotator cuff tears and highlights their progressive nature leading to cuff tear arthropathy [19].

Snyder: The Snyder classification system is reproducible and utilized for analyzing treatment options of partial rotator cuff tears [52].

ISAKOS: The ISAKOS rotator cuff tear classification system provides sufficient interobserver reliability for communicating among surgeons and for pooling data from clinical studies [71].

Glenoid Bone Loss: The proposed classification system for glenoid bone loss serves as a helpful guide to the degree of bone loss when embarking on revision shoulder arthroplasty [49].

LHB Instability: A new arthroscopic classification was created based on the association between long head of biceps (LHB) instability, LHB lesions, and rotator cuff tear size [72].

Other Considerations: Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair [8]. With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons [59]. A comprehensive classification system integrating historical and newer descriptions of rotator cuff lesions may help to guide treatment further [43]. A comprehensive rotator cuff tear classification scheme encompassing 97% of all tears was described to facilitate anatomic repair [44]. A study aimed to determine which classification system is the most useful for evaluating preoperative supraspinatus tendon retraction in terms of predictive value for postoperative retear in arthroscopic rotator cuff repair [51]. This classification system may be useful to anticipate the complexity of humeral reconstruction in revision total shoulder arthroplasty [58]. A simple scoring system for patients with recurrent rotator cuff tear based on 6 preoperative characteristics was optimized to predict good clinical outcomes 2 years after revision rotator cuff repair [66]. A structured core set of local events associated with arthroscopic rotator cuff repair has been developed by international consensus [69]. The most common cause of revision surgery in patients aged 70 years or older with glenohumeral osteoarthritis following primary anatomic total shoulder arthroplasty is rotator cuff tears [18]. The most common cause of revision surgery in patients aged 70 years or older with glenohumeral osteoarthritis following primary reverse total shoulder arthroplasty is glenoid component loosening [18].

Clinical Presentation

Patients presenting for revision rotator cuff repair typically exhibit persistent clinical symptoms despite nonsurgical management, provided no substantial risk factors for failure are present [2]. While most functional improvement and pain relief after initial repair occur within the first 6 months and continue through 24 months, these patients often fail to achieve such outcomes [48]. Revision surgery offers significant improvement in both pain and function at 5 years postoperation, though results remain inferior to primary repair [3]. Long-term follow-up (minimum 10 years) confirms that revision rotator cuff repair provides significant pain relief and functional score improvement [13].

Radiographic evaluation is critical for identifying structural predictors of failure. Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears [11]. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and referral to a shoulder specialist are recommended [11]. Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair [12]. Ultrasound (US) imaging serves as a highly sensitive and specific test for detecting recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR [15].

Specific patient histories and injury patterns correlate with higher failure rates. Patients who had revision rotator cuff repair were twice as likely to have re-torn compared to those undergoing primary repair by two years [1]. Recurrent rotator cuff tears are not uncommon after arthroscopic repair of large and massive tears [46]. Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis [45]. In patients with a rotator cuff repair after a traumatic shoulder dislocation, the incidence of re-interventions was 10%, with the main cause being a symptomatic rotator cuff re-tear [47].

Arthroscopic revision rotator cuff repair is a reasonable treatment option even after prior open repairs, providing improved pain relief and shoulder function [6]. Prospective and retrospective studies report similar revision rates after arthroscopic rotator cuff repairs [4]. Revision surgery with rotator cuff repair can provide symptomatic and functional improvement [9].

Investigations

Plain radiography: Radiographic changes occur in 40% of patients within 5 years after arthroscopic rotator cuff repair [12]. The Hamada classification is a commonly used scheme that employs a mechanistic approach to explain radiographic changes in chronic massive tears, highlighting the progressive nature leading to cuff tear arthropathy (CTA) [19]. Preoperative radiographic diagnosis of posterior and anterior glenohumeral registry can help anticipate intraoperative rotator cuff deficiency [111]. The presence of radiographic degenerative changes is associated with worse outcomes and a need for revision to reverse shoulder arthroplasty [94].

MRI: Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of the rotator cuff after repair [8]. Substantial variability exists when evaluating MRI scans after rotator cuff repair [98]. Advances in imaging have improved the detection of delaminated rotator cuff tears [107]. Preoperative MRI scans interpreted by orthopaedic surgeons using a systematic approach result in improved accuracy for diagnosing subscapularis tendon tears compared with previous studies [99]. However, preoperative MRI scans do not reliably predict which rotator cuff injury patients have subscapularis tendon tears [124]. In 18 of 22 patients (82%) with partial-thickness tears treated with tear completion followed by surgical repair, no full-thickness or near full–thickness defect was seen on follow-up MRI at a minimum of 2 years [91]. After successful arthroscopic repair, muscle volume increases slightly (11.3%-13.9%) from preoperatively to final follow-up [100]. Most deformities remodel over time and do not affect the radiologic outcome of repair after 6 months of follow-up [104]. Although MRI data suggest improved healing rates in single-row repairs in the entire population, double-row repair shows improved radiographic healing when similar-sized tears are compared [114]. The presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic total shoulder replacement in the medium term [102].

Ultrasound: Ultrasound imaging is a highly sensitive and specific test for detecting recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR [15].

Other Considerations: Traumatic and degenerative rotator cuff repairs lead to comparable clinical and radiologic results [93]. The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort is higher than previously reported [118]. An attempt at rotator cuff repair significantly decreases pain and significantly improves function and strength even if MRI documents that the repair has failed [113].

Treatment

Non-Operative

Nonoperative treatment is appropriate as initial therapy for partial-thickness tears, while operative management is considered when nonoperative treatment fails [87]. Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with patients allocated to surgery improving to a greater degree across three years of follow-up [81]. Nonoperative treatment has been shown to be efficacious for patients with chronic, massive, irreparable rotator cuff tears despite low-quality evidence [82]. All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty [75].

Operative

Indications: The major indication for revision rotator cuff repair is the persistence of clinical symptoms despite nonsurgical management in the absence of substantial risk factors for failure [2]. Chronic preoperative opioid use is independently associated with an increased risk of revision surgery after rotator cuff repair [101], and patients with prolonged preoperative opioid prescriptions had increased rates of revision within both 6 months and 1 year following rotator cuff repair [112]. Arthroscopic examination and attempted repair of large and massive rotator cuff tears is considered the gold standard of treatment for nonarthritic shoulders, cautioning against the high complication and reoperation rates associated with reverse total shoulder replacements in younger patients [79].

Surgical Approach / Technique: Revision rotator cuff repair is technically more difficult than primary repair due to poor tissue quality, adhesions, and retained hardware [21]. Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs, providing improved pain relief and shoulder function [6]. Revision arthroscopic rotator cuff repair can provide significant improvements in pain and function, with repair integrity dependent on adequate tendon mobilization and appropriate surgical technique [60]. Arthroscopy has become the gold standard for rotator cuff repair due to reduced invasiveness and fewer complications, though results still include a large number of recurrences [54]. Prospective and retrospective studies report similar revision rates after arthroscopic rotator cuff repairs [4]. There is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair for partial thickness tears [50]. Initial reports of graft augmentation demonstrate clinical improvements that could significantly change treatment approaches for rotator cuff repair [5].

Implant Selection: Reverse shoulder arthroplasty is a versatile revision option following failure of primary procedures including failed shoulder arthroplasty, rotator cuff repair, or proximal humerus open reduction and internal fixation [103]. The most revised implants for humeral loosening were anatomic total shoulder arthroplasties and reverse shoulder arthroplasties, with reverse shoulder arthroplasties being the most common implant used for revision [97]. A novel approach for salvage of a poorly functioning anatomic total shoulder replacement using a custom-made reverse total shoulder prosthesis allows conversion without the need to bone graft the resulting defect caused by removing a well-fixed ingrowth glenoid [127]. The revision risk with constrained reverse total shoulder implants for proximal humerus tumors was higher than reported for other proximal humerus prostheses, likely due to increased stresses at the humeral component-bone interface causing aseptic loosening [121]. Pyrocarbon interposition shoulder arthroplasty should remain to be tested in a few specialized shoulder centers until long-term results are available [117].

Pain Management: The majority of shoulder surgeons use standardized perioperative and postoperative pain management protocols [96]. Interscalene block combined with multimodal pain control is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair [89]. Multimodal analgesia for rotator cuff repair should be individualized based on surgical location, complexity, and patient comorbidity, with interscalene block preferred for complex anterior procedures unless respiratory comorbidities are present, in which case periarticular infiltration combined with pharmacologic therapies is recommended [106]. A new nerve block procedure for the suprascapular nerve is expected to be a useful management tool for pain relief after rotator cuff repair in the future [108].

Other Considerations: Treatment of massive rotator cuff tears has evolved from conservative management to advanced surgical techniques including arthroscopic repair, muscle transfers, and reversed arthroplasty [63]. Operative treatment for midshaft clavicle fractures leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports, and lower rates of non-union compared with conservative treatment, but is associated with an increased risk of complications and re-operations while long-term shoulder functional outcomes are similar [85]. Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1 year postoperatively [115].

Revision

Patients undergoing revision rotator cuff repair are twice as likely to have a re-tear compared to those undergoing primary repair by two years post-operation [1]. Revision rotator cuff repair provides significant improvement in pain and function at 5 years post-operation, though outcomes are not as good as primary repair [3]. The results of revision rotator cuff repair are inferior to those of primary repair [7]. Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up (minimum 10 years) [13]. Revision surgery with rotator cuff repair can provide symptomatic and functional improvement [9]. Even if revision may lead to several procedures in the same patient, preservation or replacement of the reverse shoulder arthroplasty is largely possible, allowing for a functional shoulder [125]. Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years [22]. Revision of an infected reverse shoulder arthroplasty is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal [105]. Indications for initial shoulder replacement do not influence the clinical outcome after conversion to reverse total shoulder arthroplasty at long-term follow-up [76]. When the glenoid component revision is the indication for revision total shoulder replacement, these patients tend to achieve good to excellent results [17].

Complications

Infection (PJI): The overall incidence of infection following arthroscopic rotator cuff repair is 8.5 per 1000 repairs over a 10-year period [116]. Revision surgery, particularly in the setting of prior infection, increases the risk of future infection after shoulder arthroplasty [154]. The risk of infection after primary shoulder arthroplasty is significantly higher in patients with a history of prior nonarthroplasty-related surgery [157]. Single-stage revision for shoulder periprosthetic joint infection is an effective treatment with a low recurrence rate of 6.3% for C. acnes or other sensitive, low-virulence organisms [144]. Patients undergoing treatment of shoulder periprosthetic joint infection with debridement, antibiotics, and implant retention (DAIR) did not have an increased rate of reinfection compared with single-stage and two-stage revision procedures [129]. Staged revision reverse total shoulder arthroplasty proved successful in the ultimate eradication of periprosthetic joint infection, although there were several patients who required an additional stage of treatment and a significant complication rate [159]. Shoulder arthroplasty in patients with a history of periprosthetic joint infection complicating hip or knee arthroplasty seems to be safe, with a low rate of infection [156]. The overall incidence of revision due to infection is low, though reverse shoulder arthroplasty has a higher risk of revision due to infection than anatomical shoulder arthroplasty [153].

Aseptic loosening: The most common causes of revision surgery differ between total shoulder arthroplasty (rotator cuff tears) and reverse total shoulder arthroplasty (glenoid component loosening), despite similar overall revision risks [18]. Fifty-two percent of revision shoulder arthroplasty cases with humeral loosening are aseptic [110]. Cement-within-cement technique in revision reverse total shoulder arthroplasty is associated with higher rates of complications and re-revision surgery over time secondary to aseptic glenoid component loosening and instability [90].

Instability: Cement-within-cement technique in revision reverse total shoulder arthroplasty is associated with higher rates of complications and re-revision surgery over time secondary to aseptic glenoid component loosening and instability [90].

Thromboembolism: Venous thromboembolism is a rare complication following rotator cuff repair, occurring in 0.3% of cases [92]. The prevalence of deep-vein thrombosis following reconstructive shoulder arthroplasty is 13.0% [86]. Incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay [128].

Wound complications: Patients undergoing open rotator cuff repair have higher risks of any adverse event, readmission rates, and major surgical site infections compared to arthroscopic repair within 30 days [139]. Patients undergoing open rotator cuff repair have higher risks of any adverse event, readmission rates, and major surgical site infections compared to arthroscopic repair within 30 days [140]. Wound complications and revision rates in patients undergoing shoulder arthroplasty who require postoperative therapeutic anticoagulation are significantly elevated compared with controls [142]. Allogeneic red blood cell transfusion increases the risk of surgical site infection after shoulder arthroplasty in a dose-dependent manner [154].

Other Considerations: Patients undergoing revision rotator cuff repair are twice as likely to have a re-tear compared to those undergoing primary repair by two years [1]. The results of revision rotator cuff repair are inferior to those of primary repair [7]. Revision rotator cuff repair is technically more difficult than primary repair due to poor tissue quality, adhesions, and retained hardware [21]. Patients undergoing revision rotator cuff repair should not expect to see the same improvements in range of motion that may occur after primary repair [143]. The complication rate after arthroscopic revision rotator cuff repair is about twice the published rate for primary rotator cuff repair [95]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [22]. Complications and reoperation rates for revision reverse shoulder arthroplasty are higher than those for primary reverse shoulder arthroplasty, though outcomes are comparable for revision of failed anatomic shoulder arthroplasty [134]. Revision reverse shoulder arthroplasty or primary reverse shoulder arthroplasty for fracture sequelae and tumors are at high risk for revision [137]. Primary reverse shoulder arthroplasty in patients aged 65 years or younger yields good short-term to medium-term outcomes with high implant survival [146]. Primary reverse shoulder arthroplasty for cuff-deficient shoulders or primary osteoarthritis leads to a high 10-year survival [137]. Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision [141]. Revision shoulder arthroplasty is being performed at a mean of 3.9 years from the primary procedure [148]. Second complications in patients with primary malignant bone tumors occur relatively soon after the first revision [138]. Adverse events after rotator cuff repair may occur in almost 1 of 5 cases according to clinical registries [131]. Rotator cuff repair has a low incidence of short-term complications [135]. Major complications are infrequent following distal biceps repair, and few patients require revision surgery [147]. The incidence and risk of 30-day perioperative complications are similar after arthroscopic and open irrigation and debridement for septic arthritis of the shoulder [155]. Complications following rotator cuff repair occur at increased rates in HIV-infected patients relative to non-infected patients [158]. Nearly a quarter of all solid organ transplant patients experience a perioperative complication following rotator cuff repair [136]. Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications and subsequent shoulder surgery [152]. Smoking increases the risk for revision, reoperation, and complications in patients aged 65 years or younger undergoing primary reverse shoulder arthroplasty [146].

Recovery

Light activity (weeks): Patients undergoing arthroscopic rotator cuff repair can typically resume desk work, driving, and light activities of daily living within the first few weeks, with a vast majority of injured workers returning to previous work at approximately 8 months after surgery [56]. Arthroscopic repair portends favorable outcomes and high rates of return to work in manual laborers, with 89.6% of patients able to return to work [73], and a vast majority of patients can expect to return to work within 8 months of surgery [78].

Full activity (months): Functional recovery based on clinical outcomes shows approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair [149]. In a 5-year follow-up study, arthroscopic superior capsule reconstruction restored shoulder function and resulted in high rates of return to recreational sport and work [109, 119]. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity [120].

Complete recovery / outcome plateau (months): The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points [74, 77]. Although recovery of the ability to sleep comfortably plateaued at 6 months, the achieved improvements in sleep are maintained more than 4 years after rotator cuff repair without evidence for the re-emergence of sleep disturbance [145]. At long-term follow-up (≥15 years), the patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable over a period of 15 years [88].

Rehabilitation protocol: One-year follow-up is not the last word for rotator cuff repair outcomes; patients must live with the long-term outcomes of surgical procedures [20]. At a minimum of 1-year follow-up after rotator cuff repair, patients should expect similar improvement in pain and validated outcome measures for each side, though they may experience more pain during the middle portion of recovery on the contralateral side [150].

Functional milestones: Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation, though not as good as primary repair [3]. By two years, patients who had revision rotator cuff repair were twice as likely to have re-torn compared to those undergoing primary repair [1]. The results of revision rotator cuff repair are inferior to those of primary repair [7]. The results of revision surgery for persistent subacromial impingement are inferior to reported results after primary acromioplasty or rotator cuff repair [123]. During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low [151].

Other Considerations: Patients must be counseled that while revision surgery offers significant improvement, the structural integrity and functional outcomes remain inferior to primary repair [3, 7]. The durability of outcomes is evident at 15 years for all-arthroscopic techniques [88], yet the risk of re-tear is significantly elevated in revision cases compared to primary repairs [1].

Key Evidence

• [L3] However, by two years, patients who had revision rotator cuff repair were twice as likely to have re-torn compared to those undergoing primary repair. (10.1016/j.jse.2015.05.015)
• [L5] The major indication for revision rotator cuff repair is the persistence of clinical symptoms despite nonsurgical management in the absence of substantial risk factors for failure. (10.5435/00124635-201111000-00002)
• [L4] Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation, though not as good as primary repair. (10.1016/j.jse.2019.12.011)
• [L1] Prospective and retrospective studies report similar revision rates after arthroscopic rotator cuff repairs. (10.1016/j.asmr.2024.100993)
• [L5] Despite little evidence of drastic outcome improvements in arthroscopic rotator cuff repair over the last 30 years, initial reports of graft augmentation demonstrate clinical improvements that could significantly change treatment approaches. (10.1016/j.arthro.2021.11.035)
• [L4] Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs and provides both improved pain relief and shoulder function. (10.1177/0363546509346401)
• [L4] Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair. (10.1007/s00167-014-3486-3)
• [L4] Revision surgery with rotator cuff repair can provide symptomatic and functional improvement. (10.1016/j.jse.2011.08.054)
• [L4] When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended. (10.1016/j.jseint.2020.09.015)
• [L3] Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. (10.1177/23259671221126095)
• [L4] Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. (10.1016/j.jse.2023.06.009)
• [L3] US imaging is a highly sensitive and specific test for the detection of recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR. (10.1016/j.jse.2017.12.017)
• [Abstract] When the glenoid component revision is the indication for revision total shoulder replacement, these patients tend to achieve good to excellent results. (10.1016/j.jse.2007.02.098)
• [L3] Although revision risk was similar, the most common causes of revision were different, with rotator cuff tears in TSA patients and glenoid component loosening in RTSA patients. (10.1016/j.jse.2023.03.021)
• [L5] The Hamada classification is a commonly used classification scheme that uses a mechanistic approach to explain the radiographic changes seen with chronic massive rotator cuff tears, highlighting the progressive nature of massive rotator cuff tears leading to CTA. (10.1007/s11999-017-5340-7)
• [L5] One-year follow-up is not the last word for rotator cuff repair outcomes; patients must live with the long-term outcomes of surgical procedures, and authors are obliged to evaluate these long-term outcomes. (10.1016/j.arthro.2024.12.040)
• [L5] Revision rotator cuff repair is technically more difficult than primary repair due to poor tissue quality, adhesions, and retained hardware. (10.1016/j.jse.2011.11.029)
• [L3] Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years. (10.1302/0301-620x.107b11.bjj-2025-0436.r1)
• [L5] The biomechanical shoulder model is consistent with clinical observations. (10.1016/j.jse.2016.05.031)
• [L4] The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder. (10.1016/j.asmr.2023.100804)
• [L4] The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. (10.1016/j.jse.2015.10.021)
• [L5] Optimal scapular function is a key component of all shoulder function, and alterations in scapular motion are associated with most types of shoulder pathology. (10.5435/jaaos-20-06-364)
• [L4] Alterations of scapular kinematics in symptomatic subjects are multifactorial. (10.1016/j.jse.2015.04.007)
• [L5] In this cadaveric shoulder model of the throwing shoulder, tears of the posterior rotator cuff cable lead to altered glenohumeral biomechanics and kinematics. (10.1177/2325967117s00373)
• [L5] In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels. (10.1016/j.jse.2020.03.007)
• [L5] In this dynamic shoulder model, performing an SCR only partially restored native glenohumeral joint loads. (10.1016/j.jisako.2023.03.404)
• [L5] In this dynamic shoulder model, performing an SCR only partially restored native glenohumeral joint loads. (10.1016/j.jisako.2023.03.405)
• [L3] Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology. (10.1016/j.jse.2016.11.048)
• [L4] RTSA shoulders show kinematics that are significantly different from normal shoulders, using more scapulothoracic motion and less glenohumeral motion to elevate the arm. (10.1016/j.jse.2014.11.043)
• [L4] This study utilized 4DCT to characterize age-related differences in shoulder kinematics, revealing that older asymptomatic males exhibit altered glenohumeral and scapulothoracic motion patterns compared to younger males during dynamic tasks. (10.1016/j.jseint.2025.10.007)
• [L5] In this dynamic shoulder model, SCR only partially restored native glenohumeral joint loads. (10.1016/j.arthro.2023.02.019)
• [L5] Tears of the subscapularis have greater biomechanical consequences than do tears of the infraspinatus. (10.1016/j.arthro.2009.09.007)
• [L5] While each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its pre-injured state. (10.1016/j.jse.2023.02.047)
• [L4] The goal of tendon transfers is to achieve stable kinematics by restoring rotational strength and force coupling of the shoulder joint. (10.1530/eor-22-0023)
• [L5] Simulated anterosuperior rotator cuff tears involving the superior half of the subscapularis significantly alter shoulder biomechanics and lead to increased anterosuperior and superior glenohumeral translation under higher loads. (10.1016/j.arthro.2008.10.005)
• [L3] However, A-P glenohumeral kinematics was not fully restored after BR, and its effect on long-term clinical outcomes requires further investigation. (10.1177/03635465241301778)
• [Abstract] The 3D glenohumeral kinematics at the early phase of arm elevation may affect the shoulder function in patients with massive rotator cuff tears. (10.1016/j.jse.2020.01.004)
• [L4] A comprehensive classification system integrating historical and newer descriptions of rotator cuff lesions may help to guide treatment further. (10.1302/2058-5241.1.160005)
• [L4] A comprehensive rotator cuff tear classification scheme encompassing 97% of all tears was described to facilitate anatomic repair. (10.1016/j.arthro.2007.05.002)
• [L3] Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis. (10.1016/j.jse.2023.12.015)
• [L3] Recurrent rotator cuff tears are not uncommon after arthroscopic repair of large and massive tears. (10.1177/0363546511413372)
• [L3] The incidence of re-interventions was 10% and the main cause was a symptomatic rotator cuff re-tear. (10.1016/j.jse.2021.03.051)
• [L2] Rotator cuff repairs provide sustained clinical improvement out past 5 years, with most functional improvement and pain relief occurring within the first 6 months but continuing to 24 months. (10.1177/23259671221119222)
• [L4] The proposed classification system is a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty. (10.1302/0301-620x.98b3.36664)
• [L5] While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. (10.1155/2015/458786)
• [L4] The study aimed to determine which classification system is the most useful for evaluating preoperative supraspinatus tendon retraction in terms of predictive value for postoperative retear in arthroscopic rotator cuff repair. (10.1016/j.jse.2018.05.014)
• [L2] The Snyder classification system is reproducible and can be used in future research studies in analyzing the treatment options of partial rotator cuff tears. (10.1177/2325967116667058)
• [L5] Arthroscopy has become the gold standard for rotator cuff repair due to reduced invasiveness and fewer complications, though results still include a large number of recurrences. (10.1007/s00167-015-3515-x)
• [L4] The majority of injured workers undergoing rotator cuff repair return to previous work at approximately 8 months after surgery. (10.1177/0363546520975426)
• [L3] This classification system may be useful to anticipate the complexity of humeral reconstruction. (10.1097/corr.0000000000000590)
• [L2] With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. (10.1177/0363546506298108)
• [L4] Revision arthroscopic rotator cuff repair can provide significant improvements in pain and function, with repair integrity dependent on adequate tendon mobilization and appropriate surgical technique. (10.2106/jbjs.j.01173)
• [L5] Treatment of massive rotator cuff tears has evolved from conservative management to advanced surgical techniques including arthroscopic repair, muscle transfers, and reversed arthroplasty. (10.1007/s00167-014-3470-y)
• [L4] Arthroscopic rotator cuff repair has evolved into one of the most common orthopedic surgical procedures worldwide, yet there is still much work to be carried out to improve healing rates, outcomes, and long-term durability. (10.1016/j.xrrt.2021.01.004)
• [L4] A simple scoring system for patients with recurrent rotator cuff tear based on 6 preoperative characteristics was optimized to predict good clinical outcomes 2 years after revision rotator cuff repair. (10.1016/j.jse.2024.12.034)
• [L5] A structured core set of local events associated with arthroscopic rotator cuff repair has been developed by international consensus. (10.1016/j.jse.2016.04.036)
• [L2] The ISAKOS rotator cuff tear classification system provides sufficient interobserver reliability for communicating among surgeons and for pooling of data from clinical studies. (10.1016/j.jisako.2021.12.004)
• [L4] LHB instability was associated with LHB lesions and rotator cuff tear size, leading to the creation of a new arthroscopic classification. (10.1016/j.arthro.2006.08.025)
• [L4] Arthroscopic rotator cuff repair portended favorable outcomes and high rates of return to work in this cohort of manual laborers, with 89.6% of patients able to return to work. (10.1177/03635465221097102)
• [L4] The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. (10.1016/j.arthro.2017.04.033)
• [L4] All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. (10.1007/s00167-022-07099-9)
• [Abstract] At long-term follow-up, indications for initial shoulder replacement do not influence the clinical outcome after conversion to reverse total shoulder arthroplasty. (10.1016/j.jse.2022.01.004)
• [L4] The plateau of maximum recovery after rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. (10.1016/j.jse.2016.11.002)
• [L3] A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. (10.1177/2325967119878415)
• [L5] The author considers arthroscopic examination and attempted repair of large and massive rotator cuff tears to be the gold standard of treatment for nonarthritic shoulders, cautioning against the high complication and reoperation rates associated with reverse total shoulder replacements in younger patients. (10.1016/j.arthro.2017.10.036)
• [L5] The widely accepted 2-year benchmark for rotator cuff repair outcomes may be arbitrary and does not add clinical relevance, as 1-year follow-up appears clinically sufficient. (10.1016/j.arthro.2023.11.002)
• [L3] Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with patients allocated to surgery improving to a greater degree across three years of follow-up. (10.1177/2325967113s00100)
• [L1] Despite low-quality evidence, nonoperative treatment has been shown to be efficacious for patients with chronic, massive, irreparable rotator cuff tears. (10.1016/j.jse.2020.11.002)
• [L5] Shoulder surgeons must carefully interpret literature comparing open and arthroscopic rotator cuff repair outcomes, as differences in complications may be influenced by selection bias and narrowing indications for open repair. (10.1016/j.arthro.2017.11.026)
• [L1] Combined acromioplasty and rotator cuff repair offer no significant long-term benefits in patient-reported outcomes or secondary surgery when compared to arthroscopic rotator cuff repair alone. (10.1016/j.arthro.2018.10.023)
• [L4] Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment, but is associated with an increased risk of complications and re-operations while long-term shoulder functional outcomes are similar. (10.1302/2058-5241.3.170033)
• [Abstract] This is the first study to report the prevalence of DVT following reconstructive shoulder arthroplasty surgery (13.0%). (10.1016/j.jse.2007.02.097)
• [L5] Nonoperative treatment is appropriate as initial therapy, while operative management including arthroscopic subacromial decompression, debridement, or repair is considered when nonoperative treatment fails. (10.5435/00124635-199901000-00004)
• [L4] At long-term follow-up (≥15 years), the patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable over a period of 15 years. (10.1016/j.jse.2022.01.116)
• [L2] It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair. (10.1007/s00167-012-2272-3)
• [L4] Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability. (10.1016/j.xrrt.2024.08.006)
• [L4] In 18 of 22 patients (82%) with partial-thickness rotator cuff tears treated with tear completion followed by surgical repair, there was no evidence of a full-thickness or near full–thickness defect on follow-up MRI at a minimum of 2 years. (10.1016/j.arthro.2010.08.017)
• [L3] Venous thromboembolism is a rare complication following rotator cuff repair (0.3%). (10.1016/j.arthro.2019.05.045)
• [L3] Traumatic and degenerative rotator cuff repairs lead to comparable clinical and radiologic results. (10.1016/j.asmr.2023.100867)
• [L4] The presence of radiographic degenerative changes did lead to a worse outcome and the need for revision to reverse shoulder arthroplasty. (10.1016/j.jse.2019.04.021)
• [L4] The complication rate after arthroscopic revision rotator cuff repair is about twice the published rate for primary rotator cuff repair. (10.1016/j.arthro.2013.06.015)
• [L4] The majority of shoulder surgeons use standardized perioperative and postoperative pain management protocols. (10.1016/j.jse.2017.10.005)
• [L4] The most revised implants for humeral loosening were anatomic total shoulder arthroplasties and reverse shoulder arthroplasties, with reverse shoulder arthroplasties being the most common implant used for revision. (10.1016/j.jse.2024.08.053)
• [L3] The results of this study indicate that there is substantial variability when evaluating MRI scans after rotator cuff repair. (10.1177/0363546512449424)
• [L3] Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with the described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies. (10.1016/j.arthro.2012.04.142)
• [L4] After successful arthroscopic rotator cuff repair, there was a slight (11.3%-13.9%) increase in muscle volume from preoperatively to final follow-up, as seen on serial MRI. (10.1177/0363546515625211)
• [Commentary] Chronic preoperative opioid use is independently associated with an increased risk of revision surgery after rotator cuff repair, highlighting the need for a concerted effort to address opioid use in orthopaedic surgery. (10.1016/j.arthro.2020.12.219)
• [L4] The presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic total shoulder replacement in the medium term. (10.1016/j.jse.2020.07.037)
• [L5] Reverse shoulder arthroplasty is a versatile revision option following failure of primary procedures including failed shoulder arthroplasty, rotator cuff repair, or proximal humerus open reduction and internal fixation, with a large body of literature demonstrating its success. (10.1016/j.jseint.2025.02.019)
• [L3] Most deformities after rotator cuff repair remodel over time and do not affect the radiologic outcome of repair after 6 months of follow-up. (10.1016/j.arthro.2013.07.023)
• [L4] Revision of the implant is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal. (10.1016/j.jse.2015.03.007)
• [L5] Multimodal analgesia for rotator cuff repair should be individualized based on surgical location, complexity, and patient comorbidity, with interscalene block preferred for complex anterior procedures unless respiratory comorbidities are present, in which case periarticular infiltration combined with pharmacologic therapies is recommended. (10.1016/j.arthro.2024.06.010)
• [L5] Advances in imaging and surgical techniques have improved the detection of delaminated rotator cuff tears. (10.3390/diagnostics13061133)
• [L5] We expect it will be a useful management tool for pain relief after rotator cuff repair in the future. (10.1016/j.jse.2009.01.005)
• [L4] In this 5-year follow-up study, healed arthroscopic superior capsule reconstruction restored shoulder function and resulted in high rates of return to recreational sport and work. (10.2106/jbjs.19.00135)
• [L4] Fifty-two percent of revision shoulder arthroplasty cases with humeral loosening were aseptic. (10.1016/j.jse.2024.03.004)
• [L2] Preoperative radiographic diagnosis of posterior and anterior glenohumeral registry can help anticipate intraoperative rotator cuff deficiency. (10.1016/j.jse.2019.04.005)
• [L3] Patients with prolonged preoperative opioid prescriptions had increased rates of revision within both 6 months and 1 year following rotator cuff repair. (10.1016/j.arthro.2020.11.046)
• [L3] Although MRI data suggest improved healing rates in SR repairs in the entire patient population, DR repair showed improved radiographic healing when similar-sized tears were compared. (10.1016/j.arthro.2010.03.013)
• [L4] Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1 year postoperatively. (10.1016/j.arthro.2017.03.029)
• [L3] The overall incidence of infection was 8.5/1000 arthroscopic rotator cuff repairs over a 10-year period. (10.1007/s00167-016-4202-2)
• [L4] Until long-term results are available, this type of innovative implant should remain to be tested in a few specialized shoulder centers. (10.1016/j.jse.2017.01.002)
• [L4] The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. (10.1016/j.arthro.2019.11.127)
• [L3] In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. (10.1177/2325967119s00194)
• [L3] At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity. (10.1155/2013/914148)
• [L4] The revision risk with this constrained reverse total shoulder implant was higher than reported for other proximal humerus prostheses, likely due to increased stresses at the humeral component-bone interface causing aseptic loosening. (10.1097/corr.0000000000001245)
• [L5] The results of revision surgery for persistent subacromial impingement are inferior to reported results after primary acromioplasty or rotator cuff repair. (10.5435/00124635-199703000-00005)
• [L3] Preoperative MRI scans of the shoulder do not reliably predict which rotator cuff injury patients have subscapularis tendon tears. (10.1016/j.arthro.2010.02.028)
• [L4] Even if revision may lead to several procedures in the same patient, preservation or replacement of the RSA is largely possible, allowing for a functional shoulder. (10.1016/j.jse.2013.02.004)
• [Case_report] This case demonstrates a novel approach for salvage of a poorly functioning anatomic total shoulder replacement using a custom-made reverse total shoulder prosthesis, allowing conversion without the need to bone graft the resulting defect caused by removing a well-fixed ingrowth glenoid. (10.1016/j.jse.2009.03.020)
• [L3] Although the rate of short-term complications after arthroscopic rotator cuff repair is low, incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay. (10.1177/2325967119860752)
• [L3] Patients undergoing treatment of shoulder PJI with DAIR did not have an increased rate of reinfection compared with single-stage and 2-stage revision procedures. (10.1016/j.jse.2023.06.012)
• [L5] Clinical registries are a highly beneficial source of information showing that adverse events after rotator cuff repair may occur in almost 1 of 5 cases, but retrospective review of registry data has limitations including inconsistent reporting, lack of control of confounding variables, and loss to follow-up. (10.1016/j.arthro.2020.10.045)
• [L4] Complications and reoperation rates were higher than those for primary RSA but outcomes were comparable for revision of failed anatomic shoulder arthroplasty. (10.1016/j.jse.2023.06.039)
• [L4] Rotator cuff repair has a low incidence of short-term complications. (10.1016/j.arthro.2017.10.040)
• [L3] With nearly a quarter of all SOT patients experiencing a perioperative complication following rotator cuff repair, careful consideration for surgery as well as increased postoperative surveillance should be considered in this unique population. (10.1016/j.jse.2020.12.024)
• [L3] Primary RSA for cuff-deficient shoulders or primary osteoarthritis leads to a high 10-year survival, but revision RSA or primary RSA for fracture sequelae and tumors are at high risk for revision. (10.3390/jcm11102677)
• [L3] With second complications occurring relatively soon after the first revision, regular orthopaedic follow-up visits are advised. (10.1097/corr.0000000000000955)
• [L3] Patients undergoing open rotator cuff repair had higher risks of any adverse event, readmission rates, and major surgical site infections compared to arthroscopic repair within 30 days. (10.1016/j.jse.2016.12.024)
• [L3] Patients undergoing open rotator cuff repair had higher risks of any adverse event, readmission rates, and major surgical site infections compared to arthroscopic repair within 30 days. (10.1016/j.jse.2016.12.023)
• [L4] Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision. (10.1016/j.xrrt.2022.08.008)
• [L3] Wound complications and revision rates in patients undergoing shoulder arthroplasty who require postoperative therapeutic anticoagulation are significantly elevated compared with controls. (10.1016/j.jse.2019.11.029)
• [L3] Revision patients should not expect to see the improvements in ROM that may occur after primary repair. (10.1016/j.jse.2024.05.011)
• [L4] Single-stage revision for shoulder PJI is an effective treatment with a low recurrence rate of 6.3% for C acnes or other sensitive, low-virulence organisms. (10.1016/j.jse.2020.05.034)
• [L4] Although recovery of the ability to sleep comfortably plateaued at 6 months, the achieved improvements in sleep are maintained more than 4 years after rotator cuff repair without evidence for the re-emergence of sleep disturbance. (10.1016/j.jse.2024.05.043)
• [L3] Primary reverse shoulder arthroplasty in patients aged 65 years or younger yields good short-term to medium-term outcomes with high implant survival, though smoking increases the risk for revision, reoperation, and complications. (10.1016/j.jse.2016.05.026)
• [L4] Major complications were infrequent, and few patients required revision surgery. (10.1016/j.jhsa.2012.06.022)
• [L4] Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure. (10.1016/j.jse.2019.12.015)
• [L3] Functional recovery based on clinical outcomes showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair. (10.1007/s00167-020-06019-z)
• [L5] At a minimum of 1-year follow-up after rotator cuff repair, patients should expect similar improvement in pain and validated outcome measures for each side, though they may experience more pain during the middle portion of recovery on the contralateral side. (10.1016/j.arthro.2018.07.025)
• [L4] During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. (10.1016/j.arthro.2018.09.026)
• [L3] TRT within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications and subsequent shoulder surgery. (10.1016/j.jseint.2025.10.002)
• [L3] The overall incidence of revision due to infection was low. (10.1302/0301-620x.101b6.bjj-2018-1348.r1)
• [L3] Revision surgery, particularly in the setting of prior infection, increased risk of future infection, and allogeneic red blood cell transfusion increases SSI risk after shoulder arthroplasty in a dose-dependent manner. (10.1016/j.jse.2017.04.006)
• [L3] The incidence and risk of 30-day perioperative complications are similar after arthroscopic and open I&D for septic arthritis of the shoulder. (10.1016/j.jse.2019.11.007)
• [L4] Shoulder arthroplasty in patients with a history of PJI complicating hip or knee arthroplasty seems to be safe, with a low rate of infection. (10.1016/j.jse.2016.05.024)
• [L2] The risk of infection after primary shoulder arthroplasty is significantly higher in patients with a history of prior nonarthroplasty-related surgery. (10.1016/j.jse.2016.10.020)
• [L3] Complications following rotator cuff repair occurred at increased rates in the HIV-infected group relative to the non-infected group. (10.1177/2325967120s00412)
• [L4] Staged revision RTSA proved successful in the ultimate eradication of the PJI, although there were several patients who required an additional stage of treatment and a significant complication rate. (10.1016/j.jse.2022.09.006)

See Also

• Rotator Cuff Repair
• Rotator Cuff
• Total shoulder arthroplasty
• Cuff Pathology
• Latarjet Procedure
• Shoulder Arthroplasty
• Reverse Shoulder Arthroplasty
• Internal Fixation
• Fractures

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[66] Predicting good clinical outcomes after revision rotator cuff repair: the revision cuff repair prediction score. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.034

[69] Complications associated with arthroscopic rotator cuff tear repair: definition of a core event set by Delphi consensus process. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.04.036

[71] Reliable interobserver and intraobserver agreement of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of rotator cuff tears. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2021.12.004

[72] Anterior and Posterior Instability of the Long Head of the Biceps Tendon in Rotator Cuff Tears: A New Classification Based on Arthroscopic Observations. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.08.025

[73] Rates of Return to Manual Labor After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221097102

[74] Speed of Recovery After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.033

[75] Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient‐reported outcomes at short‐term follow‐up: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07099-9

[76] Conversions From Anatomic Shoulder Replacements To Reverse Shoulder Arthroplasty: Do The Indications For Initial Surgery Influence The Outcome?. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.004

[77] Speed of recovery after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.002

[78] Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119878415

[79] Editorial Commentary: Put Down Your Saw and Pick Up Your Scope! Or, Why Burn Down the Bridge When the Road Ahead Is Full of Potholes? Reverse Total Shoulder Replacement Versus Arthroscopic Rotator Cuff Repair. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.10.036

[80] Editorial Commentary: One‐ and 2‐Year Outcomes Are Clinically Similar After Rotator Cuff Repair: What Are We Waiting For?. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.11.002

[81] A Prospective Follow-up of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00100

[82] Nonoperative treatment of chronic, massive irreparable rotator cuff tears: a systematic review with synthesis of a standardized rehabilitation protocol. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.11.002

[83] Editorial Commentary: Don't Throw Away the Retractors: Complications of Open Versus Arthroscopic Rotator Cuff Repair Could Be Influenced by Indications. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.11.026

[84] Randomized Prospective Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient‐Reported Outcomes at Long‐term Follow‐up. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.023

[85] Midshaft clavicle fractures. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170033

[86] Deep-Vein Thrombosis Following Reconstructive Shoulder Arthroplasty: A Prospective Observational Study. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.097

[87] Partial-Thickness Tears of the Rotator Cuff: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199901000-00004

[88] Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.116

[89] Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2272-3

[90] Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.08.006

[91] Magnetic Resonance Imaging Tendon Integrity Assessment After Arthroscopic Partial‐Thickness Rotator Cuff Repair. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.08.017

[92] Timing and Risk Factors for Venous Thromboembolism After Rotator Cuff Repair in the 30‐Day Perioperative Period. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.045

[93] Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2023.100867

[94] Outcome of Arthroscopically Assisted Lower Trapezius Transfer to Reconstruct Massive Irreparable Posterior-Superior Rotator Cuff Tears. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.021

[95] Complications After Arthroscopic Revision Rotator Cuff Repair. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.06.015

[96] Current pain prescribing habits for common shoulder operations: a survey of the American Shoulder and Elbow Surgeons membership. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.005

[97] Revision for humeral stem loosening: a systematic review. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.08.053

[98] Magnetic Resonance Imaging Identification of Rotator Cuff Retears After Repair. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512449424

[99] A Systematic Approach for Diagnosing Subscapularis Tendon Tears With Preoperative Magnetic Resonance Imaging Scans. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.142

[100] Reversibility of Supraspinatus Muscle Atrophy in Tendon-Bone Healing After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546515625211

[101] Editorial Commentary: Rotator Cuff Repair Outcomes Are Influenced by Chronic Opioid Use. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.219

[102] Preoperative partial-thickness rotator cuff tears do not compromise anatomic total shoulder replacement outcomes: medium-term follow-up. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.07.037

[103] Reverse shoulder arthroplasty in the revision setting. JSES International. 2025. DOI: 10.1016/j.jseint.2025.02.019

[104] Paper #19: Does The Deformity After Rotator Cuff Repair Remodel?. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.07.023

[105] Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.03.007

[106] Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.010

[107] Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation. Diagnostics. 2023. DOI: 10.3390/diagnostics13061133

[108] A new nerve block procedure for the suprascapular nerve based on a cadaveric study. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.01.005

[109] Five-Year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.19.00135

[110] Humeral stem loosening is not always prosthetic joint infection. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.004

[111] Improving preoperative planning of revision surgery after previous anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.005

[112] Chronic Preoperative Opioids Are Associated With Revision After Rotator Cuff Repair. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.11.046

[113] JOST, BERNHARD M.D.+; PFIRRMANN, CHRISTIAN W. A. M.D.+; GERBER, CHRISTIAN M.D.+, ZURICH, SWITZERLAND. The Journal of Bone and Joint Surgery. American Volume. 2000.

[114] Comparative Analysis of Single‐Row Versus Double‐Row Repair of Rotator Cuff Tears. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.03.013

[115] Arthroscopic Subacromial Spacer Implantation in Patients With Massive Irreparable Rotator Cuff Tears: Clinical and Radiographic Results of 39 Retrospectives Cases. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.03.029

[116] Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4202-2

[117] Pyrocarbon interposition shoulder arthroplasty: preliminary results from a prospective multicenter study at 2 years of follow-up. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.01.002

[118] Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging–Based Study. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.127

[119] Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00194

[120] Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup. Advances in Orthopedics. 2013. DOI: 10.1155/2013/914148

[121] Proximal Humerus Tumors: Higher-than-Expected Risk of Revision With Constrained Reverse Shoulder Arthroplasty. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001245

[123] Painful Shoulder After Surgery for Rotator Cuff Disease. Journal of the American Academy of Orthopaedic Surgeons. 1997. DOI: 10.5435/00124635-199703000-00005

[124] Accuracy of Preoperative Magnetic Resonance Imaging in Predicting a Subscapularis Tendon Tear Based on Arthroscopy. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.02.028

[125] Revision surgery of reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.02.004

[127] Revision to a reverse shoulder arthroplasty using a custom glenoid sphere over a well-fixed metal glenoid tray: A case report. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.020

[128] A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119860752

[129] Outcomes after débridement, antibiotics, and implant retention for prosthetic joint infection in shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.012

[131] Editorial Commentary: Adverse Events After Rotator Cuff Repair Are Not Rare: Houston, We (May) Have a Problem. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2020.10.045

[134] Revision reverse shoulder arthroplasty for the management of baseplate failure: an analysis of 676 revision reverse shoulder arthroplasty procedures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.039

[135] Risk Factors for Short‐term Complications After Rotator Cuff Repair in the United States. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.10.040

[136] Increased perioperative complication rates in patients with solid organ transplants following rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.12.024

[137] Survivorship of Reverse Shoulder Arthroplasty According to Indication, Age and Gender. Journal of Clinical Medicine. 2022. DOI: 10.3390/jcm11102677

[138] What is the Likelihood That Tumor Endoprostheses Will Experience a Second Complication After First Revision in Patients With Primary Malignant Bone Tumors And What Are Potential Risk Factors?. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000955

[139] Factors influencing direct clinical costs of outpatient arthroscopic rotator cuff repair surgery. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.024

[140] Arthroscopic vs. open rotator cuff repair: which has a better impact profile?. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.023

[141] Augmented baseplates in reverse shoulder arthroplasty: a systematic review of outcomes and complications. JSES Reviews, Reports, and Techniques. 2023. DOI: 10.1016/j.xrrt.2022.08.008

[142] Therapeutic postoperative anticoagulation is a risk factor for wound complications, infection, and revision after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.029

[143] Revision rotator cuff repair versus primary repair: an assessment of longitudinal outcomes in revision rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.011

[144] Single-stage versus two-stage revision for shoulder periprosthetic joint infection: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.05.034

[145] Improvement in sleep disturbance following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.043

[146] Primary reverse shoulder arthroplasty in patients aged 65 years or younger. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.05.026

[147] Complications Following Distal Biceps Repair. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.06.022

[148] Revision shoulder arthroplasty: a systematic review and comparison of North American vs. European outcomes and complications. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.015

[149] Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06019-z

[150] Editorial Commentary: The Second Side Is as Good as the First After Bilateral Rotator Cuff Repair: Preach Patience to the Patients. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.07.025

[151] Long‐Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.09.026

[152] Preoperative testosterone replacement therapy: a potential risk-factor for complications and reoperation after rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2025.10.002

[153] Reverse shoulder arthroplasty has a higher risk of revision due to infection than anatomical shoulder arthroplasty. The Bone & Joint Journal. 2019. DOI: 10.1302/0301-620x.101b6.bjj-2018-1348.r1

[154] Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.04.006

[155] Arthroscopic débridement has similar 30-day complications compared with open arthrotomy for the treatment of native shoulder septic arthritis: a population-based study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.007

[156] Safety and efficacy of shoulder arthroplasty following lower extremity periprosthetic joint infection. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.05.024

[157] Is previous nonarthroplasty surgery a risk factor for periprosthetic infection in primary shoulder arthroplasty?. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.10.020

[158] Rotator cuff repair in HIV-infected patients: an analysis of postoperative complications. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00412

[159] Success of staged revision reverse total shoulder arthroplasty in eradication of periprosthetic joint infection. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.006