Arthroscopic Rotator Cuff Repair: How to Avoid Retear.

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Abstract

[Indexed for MEDLINE] 6. Knee Surg Sports Traumatol Arthrosc. 2015 Feb;23(2):344-62. doi: 10.1007/s00167-014-3445-z. Epub 2014 Dec 2. History of rotator cuff surgery. Randelli P(1), Cucchi D, Ragone V, de Girolamo L, Cabitza P, Randelli M. Author information: (1)Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy, pietro.randelli@unimi.it. PURPOSE: Rotator cuff surgery is a rapidly evolving branch in orthopaedics, which has raised from a minor niche to a fully recognized subspecialty. This article summarizes its history, examining the development of its key principles and the technical advancements. METHODS: Literature was thoroughly searched, and few senior surgeons were interviewed in order to identify the significant steps in the evolution of rotator cuff surgery. RESULTS: A wide variety of surgical options is available to reduce pain and restore function after rotator cuff tears. Rotator cuff repair surgical techniques evolved from open to arthroscopic and are still in development, with new fixation techniques and biological solutions to enhance tendon healing being proposed, tested in laboratory and in clinical trials. Although good or excellent results are often obtained, there is little evidence that the results of rotator cuff repair are improving with the decades. An overall high re-tear rate remains, but patients with failed rotator cuff repairs can experience outcomes comparable with those after successful repairs. CONCLUSIONS: Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority. It is necessary to conduct high-level clinical studies, in which data relating to anatomical integrity, patient self-assessed comfort and function, together with precise description of patient's condition and surgical technique, are collected. LEVEL OF EVIDENCE: IV. DOI: 10.1007/s00167-014-3445-z