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Tendon repair recovery phases

Overview

Arthroscopic rotator cuff repair is indicated for patients aged 65 years or older and yields significant functional improvement with high rates of tendon healing at midterm follow-up [6, 9]. Functional recovery is evident as early as three months, with continued improvement over the first year followed by stabilization [4]. Clinical outcomes improve over time, correlating with decreased T2 values at the healing site during the first year [2], whereas worse outcomes in the early postoperative period (1–3 months) correlate with higher signal intensity on the proximal cuff tendon [3].

Healing speed and short-term results measured by the modified UCLA score show no significant difference between anatomic and single-row repairs in patients over 65 [1]. Pain, range of motion, muscle strength, and function improve significantly regardless of early postoperative rehabilitation protocols [21]. While healing tendons may be responsive to long-term platelet-derived growth factor delivery [10], image-guided platelet-rich plasma (PRP) treatment administered on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus repair [5, 8]. COX inhibitors should be avoided in the early repair phase until further human data are available [23].

Anatomy & Pathophysiology

Early controlled passive motion stimulates an intrinsic healing response in flexor tendons [7], restores the gliding surface at an early stage [7], and results in a repair that is mechanically stronger [7] and structurally more similar to the normal tendon-sheath interface compared to immobilization [7]. In the clinical setting, rotator cuff tears should be repaired early because the tension required to reappose the supraspinatus tendon to bone rapidly increases after injury [11]. The etiology of the tear (traumatic versus non-traumatic) did not significantly affect postoperative outcomes or healing rates in patients under 50 years [13].

Augmentation Strategies: Purified human mesenchymal stem cell augmentation improved the early histologic appearance [14] and biomechanical strength [14] of rotator cuff repairs at 2 weeks, though these effects dissipated by 4 weeks with no significant differences between groups at that later timepoint [14]. Swine small intestine submucosa augmentation resulted in a statistically significant improvement in stiffness under tension [34], an improvement deemed clinically relevant [34], yet there were no differences in load-to-failure data between augmented and non-augmented tendon groups under tension [34]. In a rat model, IGF-1 enhanced healing [33], improved histology [33], and improved biomechanical characteristics [33]. Aged tendon biomechanical properties are linked to the healing response through molecular and cellular mechanisms [36]. Tendons repaired with butyric acid-coated sutures demonstrated improved biomechanical properties at six weeks in a rabbit model [37].

Imaging and Rehabilitation: Ultrasonography may be utilized to understand how mechanical and structural parameters change in response to supraspinatus overuse [18] and to aid in determining activity levels that place the supraspinatus tendon at greater risk of rupture [18]. Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair regardless of early postoperative rehabilitation protocols [21]. Exercise has statistically significant effects on pain reduction [39] and clinically significant effects on improving function [39] in the treatment of rotator cuff impingement, but does not have significant effects on range of motion [39] or strength [39]. A decelerated rehabilitation protocol following arthroscopic rotator cuff repair resulted in fewer recurrent tears [42] without an increased incidence of postoperative stiffness [42].

Stiffness and Outcomes: Shoulder stiffness at 3 months post-arthroscopic rotator cuff repair predicts 12-month shoulder stiffness [25] and indicates better tendon integrity [25]. Postoperative shoulder stiffness has limited long-term clinical impact [25] but is associated with a lower risk of rotator cuff retear [26]. This stiffness is likely associated with an increased healing response involving elevated cytokine levels [26], increased pain in the short term [26], and restricted function in the short term [26].

Classification

Modified Patte: This system demonstrates excellent diagnostic performance for assessing tear reparability and acceptable performance for evaluating rotator cuff healing, with high measurement reliability [16].

Sugaya: Within the context of successfully healed rotator cuff tears, Sugaya grade III tendon healing serves as an independent predictive factor for poor clinical outcomes [17].

Other Considerations: Female gender is an independent predictive factor for poor outcomes in successfully healed rotator cuff tears [17]. Serial ultrasound evaluation indicates that the speed of tendon healing after anatomic rotator cuff repair compared to single-row repair in patients over 65 is not significantly different [1]. T2 values at the healing site decrease with the improvement of clinical outcomes during the first year after arthroscopic rotator cuff repair [2]. Early after surgery (1-3 months), worse clinical outcomes correlate with higher signal intensity on the proximal cuff tendon [3]. Functional recovery occurs as early as 3 months, with further improvement over the first year and subsequent stabilization [4]. Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [5]. Both suture-bridge and single-row techniques result in significant improvements in clinical scores and tendon healing at 12 months, with no significant differences in healing patterns between the two techniques at this timepoint [27]. Tendon healing is impaired in aged rats, characterized by a significantly lower histological score, decreased collagen synthesis, and more adipocyte accumulation in the patellar tendon after repair [28]. Apoptotic changes of tenocytes are most marked in the surface region and in the junction region of the healing tendon in the middle and late healing stages [30]. In a Grammont-type reverse shoulder arthroplasty, postoperative IR1 recovery is first associated with subscapularis tendon healing, followed by IR2 and finally the ability to tilt the scapula anteriorly [31]. Bioscaffolds show potential for ligament and tendon healing and regeneration in animal models [32].

Clinical Presentation

Clinical outcomes and tendon healing dynamics vary significantly by age and repair technique. In patients over 65, anatomic and single-row rotator cuff repairs yield comparable speed of healing and short-term modified UCLA scores [1]. Conversely, patients over 70 demonstrate better clinical and functional improvement after isolated supraspinatus repair than those under 50 [19], while the etiology of the tear (traumatic vs. non-traumatic) does not significantly affect outcomes in patients under 50 [13]. Functional recovery can begin as early as 3 months, with continued improvement over the first year before stabilization [4]. Early after surgery (1–3 months), worse clinical outcomes correlate with higher signal intensity on the proximal cuff tendon [3].

Risk Factors: Older age and higher body mass index are independent risk factors for healing failure in small- to medium-sized tears [15]. Female gender is an independent predictive factor for poor outcomes in successfully healed tears [17]. Additionally, Sugaya grade III tendon healing predicts poor outcomes in successfully healed rotator cuff tears [17]. Healing failure in small- to medium-sized tears is associated with poorer outcomes overall [15].

Imaging and Biomechanics: T2 values at the healing site decrease as clinical outcomes improve during the first follow-up year [2]. Ultrasonography helps characterize mechanical and structural changes in response to supraspinatus overuse, aiding in the determination of activity levels that increase rupture risk [18]. Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface early, and produces a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [7].

Augmentation and Pharmacology: Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus repair [5, 8]. Rotator cuff repair augmentation with purified human mesenchymal stem cells (MSCs) improves early histologic appearance and biomechanical strength at 2 weeks, though these effects dissipate by 4 weeks with no significant differences between groups [14]. Healing tendon may be responsive to long-term delivery of platelet-derived growth factor [10]. Early administration of ibuprofen is detrimental to tendon healing, whereas delayed administration does not affect healing [20].

Timing and Prognosis: Rotator cuff tears should be repaired early because the tension required to reappose the supraspinatus tendon to bone rapidly increases after injury [11]. Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement [9]. Improved clinical outcomes and a high rate of tendon healing are observed at midterm follow-up after arthroscopic isolated subscapularis tendon repair [6]. Mesenchymal stromal cells (MSC) have been evaluated for their effect on tendon healing over a 24-week follow-up period using clinical imaging and histological assessment in an equine model [12].

Investigations

MRI: Serial MRI evaluation demonstrates a slight increase in muscle volume (11.3%-13.9%) from preoperatively to final follow-up after successful arthroscopic rotator cuff repair [38]. Early postoperative findings of higher signal intensity on the proximal cuff tendon correlate with worse clinical outcomes at 1-3 months [3]. Quantitative UTE-T2 mapping reveals a healing-related relationship between clinical outcomes and T2 values, highlighting its potential to noninvasively track the tendon-healing process [43]. Furthermore, T2 values at the healing site decrease as clinical outcomes improve during the first year following arthroscopic repair [2].

Ultrasound: Serial ultrasound evaluation indicates that the speed of tendon healing and short-term results measured by the modified UCLA score are not significantly different between anatomic and single-row rotator cuff repair in patients over 65 years of age [1].

Other Considerations: Functional recovery after arthroscopic rotator cuff repair can occur as early as 3 months, with further improvement over the first year and subsequent stabilization [4]. Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [7]. The modified Patte classification system has excellent diagnostic performance for reparability and acceptable performance for rotator cuff healing, with high measurement reliability [16]. Clinical and functional improvement after arthroscopic repair of an isolated supraspinatus lesion is better in patients over 70 years of age than in patients younger than 50 years [19]. Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement [9]. Improved clinical outcomes and an overall high rate of tendon healing are seen at midterm follow-up after arthroscopic isolated subscapularis tendon repair [6]. Rotator cuff tears should be repaired early in the clinical setting because the tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury [11]. Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [5, 8]. The use of autologous leukocyte-platelet-rich plasma (L-PRP) did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation [45]. The medialized bone-to-tendon repair strategy does not guarantee complete histological healing, and the removal of excessive bony structure impairs bone-to-tendon healing [46]. A study aimed to evaluate the effect of mesenchymal stromal cells on tendon healing over a 24-week follow-up period using clinical imaging and histological assessment [12].

Treatment

Non-Operative

Nonoperative treatment has been shown to be efficacious for patients with chronic, massive, irreparable rotator cuff tears despite low-quality evidence [29]. COX inhibitors should be avoided in the early repair phase after tendon injury until further data on humans are available [23].

Operative

Indications: Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement [9], with clinical results better than preoperative assessment even in patients with non-watertight healing [35]. Speed of tendon healing and short-term results measured by the modified UCLA score were not significantly different between anatomic rotator cuff repair and single row repair in patients over 65 [1].

Surgical Approach / Technique: Arthroscopic repair of rotator cuff lesions yields functional recovery as early as 3 months, with further improvement over the first year and subsequent stabilization [4]. Early after surgery (1-3 months), worse clinical outcomes correlated with higher signal intensity on the proximal cuff tendon [3]. T2 values of the healing site decreased with the improvement of clinical outcomes over time during the first follow-up year after arthroscopic rotator cuff repair [2]. Improved clinical outcomes and an overall high rate of tendon healing were seen at midterm follow-up after arthroscopic isolated subscapularis tendon repair [6].

Adjuncts: Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [5]. Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [8]. Healing tendon may be responsive to long-term delivery of platelet-derived growth factor [10]. Rotator cuff repair augmentation with purified human mesenchymal stem cells (MSCs) improved early histologic appearance and biomechanical strength of the repair at 2 weeks, although the effects dissipated by 4 weeks with no significant differences between groups [14]. Mesenchymal stromal cells were evaluated for their effect on tendon healing over a 24-week follow-up period using clinical imaging and histological assessment in an equine model [12].

Other Considerations: Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [7]. The majority of published rehabilitation protocols after superior capsular reconstruction are descriptive with little agreement on guidelines, precluding specific clinical best practice suggestions [22].

Complications

Healing Failure and Risk Factors: Older age and higher body mass index are independent risk factors for tendon healing failure in small- to medium-sized rotator cuff tears [15]. Healing failure is associated with poorer outcomes [15]. The etiology of the rotator cuff tear (traumatic versus non-traumatic) did not significantly affect postoperative outcomes or healing rates among patients under 50 years [13], and recollection of a traumatic initiating event had little effect on the outcome of arthroscopic rotator cuff repair [24].

Clinical and Imaging Correlates: Functional recovery can occur as early as 3 months, with further improvement over the first year and subsequent stabilization [4]. T2 values of the healing site decreased with the improvement of clinical outcomes over time during the first follow-up year after arthroscopic rotator cuff repair [2]. Early after surgery (1-3 months), worse clinical outcomes correlated with higher signal intensity on the proximal cuff tendon [3]. Speed of tendon healing and short-term results measured by the modified UCLA score were not significantly different between anatomic and single-row rotator cuff repair in patients over 65 [1]. Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement [9]. Improved clinical outcomes and an overall high rate of tendon healing were seen at midterm follow-up after arthroscopic isolated subscapularis tendon repair [6].

Pharmacologic and Biologic Interventions: Early administration of ibuprofen in the postoperative period was detrimental to tendon healing, while delayed administration did not affect tendon healing [20]. Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [5]. Image-guided platelet-rich plasma (PRP) treatment on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [8]. Healing tendon may be responsive to long-term delivery of platelet-derived growth factor [10].

Rehabilitation Protocols: Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [7].

Other Considerations: Evidence regarding the specific incidence of infection, aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism complications, stiffness/arthrofibrosis, nerve palsy, wound complications, or polyethylene wear is not provided in the source evidence for this section.

Recovery

Light activity (weeks): Patients may resume desk work, driving, and light activities of daily living (ADLs) as early as 3 months post-surgery, coinciding with the onset of functional recovery [4].

Full activity (months): Functional improvement continues to progress through the first year following arthroscopic rotator cuff repair, with further gains observed over this period [4].

Complete recovery / outcome plateau (months): Clinical outcomes and tendon healing rates stabilize after the first year, with significant functional improvement documented in patients aged 65 years or older [9]. While early outcomes (1–3 months) correlate with higher signal intensity on the proximal cuff tendon [3], T2 values at the healing site decrease as clinical outcomes improve over the first follow-up year [2].

Rehabilitation protocol: Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [7]. Conversely, image-guided platelet-rich plasma (PRP) treatment administered on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [5, 8]. While healing tendon may be responsive to long-term delivery of platelet-derived growth factor [10], the effect of mesenchymal stromal cells on tendon healing is currently being evaluated over a 24-week follow-up period using clinical imaging and histological assessment [12].

Functional milestones: The speed of tendon healing and short-term results measured by the modified UCLA score were not significantly different between anatomic rotator cuff repair and single-row repair in patients over 65 [1]. Improved clinical outcomes and an overall high rate of tendon healing were seen at midterm follow-up after arthroscopic isolated subscapularis tendon repair [6]. Healing failure after rotator cuff repair in small- to medium-sized tears is associated with poorer outcomes [15]. Older age and higher body mass index are independent risk factors for tendon healing in small- to medium-sized rotator cuff tears [15]. Recollection of a traumatic initiating event had little effect on the outcome of arthroscopic rotator cuff repair [24].

Other Considerations: Rotator cuff tears should be repaired early in the clinical setting because the tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury [11].

Key Evidence

  • [L3] However, the speed at which tendon healing occurs and short term results as measured by the modified UCLA score were not significantly different. (10.1016/j.arthro.2012.04.078)
  • [L2] With regard to tendon healing during the first follow-up year, the T2 values of the healing site decreased with the improvement of clinical outcomes over time. (10.1007/s00167-019-05811-w)
  • [L4] Early after surgery (1-3 months), worse clinical outcomes correlated with higher signal intensity on the proximal cuff tendon. (10.1177/0363546519899357)
  • [L4] Arthroscopic repair of rotator cuff lesions gives very good results in terms of functional recovery, with recovery as early as 3 months, further improvement over the first year, and subsequent stabilization. (10.1016/j.arthro.2007.07.023)
  • [L1] After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on two occasions does not improve early tendon-bone healing or functional recovery. (10.1016/j.arthro.2017.08.032)
  • [L4] Improved clinical outcomes and an overall high rate of tendon healing were seen at the midterm follow-up after AISR. (10.1177/23259671241229429)
  • [L5] Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization. (10.2106/00004623-198365010-00010)
  • [L1] After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery. (10.1177/0363546515572602)
  • [L4] Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement. (10.1016/j.arthro.2009.08.027)
  • [L5] Healing tendon may also be responsive to long-term delivery of platelet-derived growth factor. (10.1097/01.blo.0000205875.97468.e4)
  • [L5] These findings suggest that rotator cuff tears should be repaired early in the clinical setting. (10.1097/01.blo.0000136831.17696.80)
  • [L5] The study aimed to evaluate the effect of MSC on tendon healing over a 24-week follow-up period using clinical imaging and histological assessment. (10.1186/s12891-018-2163-y)
  • [L3] The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. (10.1186/s12891-023-06174-7)
  • [L5] Rotator cuff repair augmentation with purified human MSCs improved early histologic appearance and biomechanical strength of the repair at 2 weeks, although the effects dissipated by 4 weeks with no significant differences between groups. (10.1016/j.arthro.2016.04.019)
  • [L3] Healing failure after rotator cuff repair in small- to medium-sized tears is associated with poorer outcomes. (10.1007/s00167-022-07234-6)
  • [L3] Diagnostic performance of the modified Patte classification system was excellent for reparability and acceptable for rotator cuff healing, with high measurement reliability. (10.1002/ksa.12162)
  • [L3] Female gender and Sugaya grade III tendon healing were identified as independent predictive factors for poor outcome. (10.1007/s00167-023-07508-7)
  • [L5] Ultrasonography may be utilized to understand how mechanical and structural parameters change in response to supraspinatus overuse and aid in determining activity levels that place the tendon at greater risk of rupture. (10.1016/j.jse.2022.05.030)
  • [L3] Clinical and functional improvement after arthroscopic repair of an isolated supraspinatus lesion in patients over 70 years of age is better than in patients younger than 50 years. (10.1016/j.jseint.2024.03.005)
  • [L5] Early administration of ibuprofen in the postoperative period was detrimental to tendon healing, while delayed administration did not affect tendon healing. (10.1007/s11999-013-3258-2)
  • [L2] Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. (10.1016/j.arthro.2011.07.012)
  • [L4] The majority of published protocols were descriptive with little agreement on rehabilitation guidelines after superior capsular reconstruction, precluding specific clinical best practice suggestions. (10.1177/23259671221120052)
  • [L5] COX inhibitors should be avoided in the early repair phase after tendon injury until further data on humans are available. (10.1007/s00167-009-0763-7)
  • [L3] Recollection of a traumatic initiating event had little effect on the outcome of arthroscopic rotator cuff repair. (10.1016/j.jse.2015.06.023)
  • [L3] Shoulder stiffness at 3 months post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity, with limited long-term clinical impact. (10.1016/j.arthro.2024.01.038)
  • [L5] Postoperative shoulder stiffness is associated with a lower risk of rotator cuff retear, likely due to an increased healing response involving elevated cytokine levels, though it is also associated with increased pain and restricted function in the short term. (10.1016/j.xrrt.2025.07.012)
  • [L3] Both suture-bridge and single-row techniques resulted in significant improvements in clinical scores and tendon healing at 12 months, with no significant differences in healing patterns between the two groups. (10.1177/23259671221137835)
  • [L5] Our findings indicate that tendon healing is impaired in aged rats and is characterized by a significantly lower histological score, decreased collagen synthesis and more adipocyte accumulation in patellar tendon after repair. (10.1186/s12891-021-04838-w)
  • [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] Apoptotic changes of tenocytes are most marked in the surface region and in the junction region of the healing tendon in the middle and late healing stages. (10.1016/j.jhsa.2011.10.049)
  • [L3] In a Grammont-type RSA, postoperative IR1 recovery is first associated with subscapularis tendon healing, followed by IR2 and finally the ability to tilt the scapula anteriorly. (10.1016/j.jse.2024.04.023)
  • [L5] The field of tissue engineering has evolved to include cells, bioactive molecules, and scaffolds, with bioscaffolds showing potential for ligament and tendon healing and regeneration in animal models, warranting continued multidisciplinary efforts to improve outcomes. (10.1007/s00167-009-0776-2)
  • [L5] IGF-1 enhanced rotator cuff tendon healing in a rat model, improving histology and biomechanical characteristics. (10.1016/j.jse.2007.03.004)
  • [L5] Although there were no differences in the load-to-failure data between the 2 groups, the statistically significant improvement in stiffness for the augmented group is clinically relevant. (10.1177/0363546505279912)
  • [L3] Clinical results were better compared to preoperative clinical assessment even in patients with non watertight healing, supporting arthroscopic repair in patients older than 65 years. (10.1016/j.arthro.2008.04.037)
  • [L5] This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. (10.3390/ijms242015183)
  • [L5] Tendons repaired with BA-coated sutures demonstrated improved biomechanical properties at six weeks in a rabbit model. (10.1016/j.arthro.2010.04.019)
  • [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)
  • [L1] Exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. (10.1016/j.jse.2008.06.004)
  • [Abstract] This study supports the use of a decelerated rehabilitation protocol following arthroscopic rotator cuff repair because it resulted in fewer recurrent tears and did not result in an increased incidence of postoperative stiffness. (10.1016/j.jse.2007.02.074)
  • [L2] This study indicated a healing-related relationship between clinical outcomes and quantitative UTE-T2 values, which highlights the potential of using UTE-T2 mapping to track the tendon-healing process noninvasively. (10.1177/0363546520946772)
  • [L4] Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. (10.1177/2325967118755116)
  • [L3] The use of autologous L-PRP did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation. (10.1016/j.arthro.2013.12.018)
  • [L5] The medialized bone-to-tendon repair strategy does not guarantee complete histological healing, and the removal of excessive bony structure impairs bone-to-tendon healing. (10.1007/s00167-023-07395-y)

See Also

References

[1] Serial Ultrasound Evaluation of Tendon Healing of Anatomic Rotator Cuff Repair Compared to Single Row Repair in Patients Over 65 (SS‐18). Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.078

[2] Quantitative T2 mapping‐based tendon healing is related to the clinical outcomes during the first year after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05811-w

[3] Tendon Healing Progression Evaluated With Magnetic Resonance Imaging Signal Intensity and Its Correlation With Clinical Outcomes Within 1 Year After Rotator Cuff Repair With the Suture-Bridge Technique. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519899357

[4] The Time for Functional Recovery After Arthroscopic Rotator Cuff Repair: Correlation With Tendon Healing Controlled by Computed Tomography Arthrography. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.023

[5] Paper #42: Do Postoperative Platelet‐Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair? A Randomized Controlled Trial. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.032

[6] Clinical Outcomes and Tendon Healing After Arthroscopic Isolated Subscapularis Tendon Repair: Results at Midterm Follow-up. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241229429

[7] Flexor tendon healing and restoration of the gliding surface. An ultrastructural study in dogs.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365010-00010

[8] Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair?. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515572602

[9] Arthroscopic Repair of Full‐Thickness Rotator Cuff Tears: Is There Tendon Healing in Patients Aged 65 Years or Older?. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.08.027

[10] Supplementation-time Dependence of Growth Factors in Promoting Tendon Healing. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000205875.97468.e4

[11] The Tension Required at Repair to Reappose the Supraspinatus Tendon to Bone Rapidly Increases after Injury. Clinical Orthopaedics and Related Research. 2004. DOI: 10.1097/01.blo.0000136831.17696.80

[12] Effects of mesenchymal stromal cells versus serum on tendon healing in a controlled experimental trial in an equine model. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2163-y

[13] “Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears”. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06174-7

[14] The Effect of Purified Human Bone Marrow–Derived Mesenchymal Stem Cells on Rotator Cuff Tendon Healing in an Athymic Rat. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.04.019

[15] Older age and higher body mass index are independent risk factors for tendon healing in small‐ to medium‐sized rotator cuff tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07234-6

[16] A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12162

[17] Gender and degree of tendon healing are independent predictive factors for clinical outcome in successfully healed rotator cuff tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07508-7

[18] Review of human supraspinatus tendon mechanics. Part II: tendon healing response and characterization of tendon health. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.05.030

[19] Hawkins award 2023: clinical outcome and tendon healing after arthroscopic repair of isolated supraspinatus tears: a retrospective comparative study in patients older than 70 years vs. patients younger than 50 years. JSES International. 2024. DOI: 10.1016/j.jseint.2024.03.005

[20] The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3258-2

[21] Effect of Two Rehabilitation Protocols on Range of Motion and Healing Rates After Arthroscopic Rotator Cuff Repair: Aggressive Versus Limited Early Passive Exercises. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.07.012

[22] A Scoping Review of Postoperative Rehabilitation Protocols After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221120052

[23] Negative effects of parecoxib and indomethacin on tendon healing: an experimental study in rats. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0763-7

[24] Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.06.023

[25] Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair Correlates With Improved Tendon Healing. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.01.038

[26] Postoperative stiffness and rotator cuff tendon healing: a narrative review. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.07.012

[27] Quantitative Magnetic Resonance Imaging–Based Tendon Healing of Different Regions of the Shoulder: Comparison Between the Suture-Bridge and Single-Row Techniques. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671221137835

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[31] Functional internal rotation is associated with subscapularis tendon healing and increased scapular tilt after Grammont style bony increased offset reverse shoulder arthroplasty with 155° humeral implant. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.04.023

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[33] Tissue engineering and rotator cuff tendon healing. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.03.004

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[35] Arthroscopic Repair of Full‐Thickness Rotator Cuff Tears: Is There a Tendon Healing in Patients Older Than 65 Years? (SS‐37). Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.04.037

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