• Augmentation
• Healing
• Injection
• Mesenchymal stem cells
• Repair
• Rotator cuff
• Tear

• Arthroscopic
• Early exercise
• Fixation
• Rotator cuff repair surgery

• Humans
• Randomized Controlled Trials as Topic
• Rotator Cuff Injuries/surgery
• Rotator Cuff Injuries/rehabilitation
• Rotator Cuff Injuries/physiopathology
• Arthroscopy/adverse effects
• Arthroscopy/rehabilitation
• Arthroscopy/methods
• Exercise Therapy/methods
• Range of Motion, Articular
• Immobilization/methods
• Recovery of Function
• Braces
• Treatment Outcome
• Time Factors

• acromiohumeral distance
• arthroscopic surgery
• fatty infiltration
• healing failure
• risk factors
• rotator cuff tears

• Osteoporosis
• Retear rate
• Rotator cuff injury
• Shoulder joint function
• Zoledronic acid

• Humans
• Zoledronic Acid/administration & dosage
• Zoledronic Acid/therapeutic use
• Female
• Aged
• Male
• Osteoporosis/drug therapy
• Retrospective Studies
• Rotator Cuff Injuries/surgery
• Rotator Cuff Injuries/drug therapy
• Range of Motion, Articular/drug effects
• Treatment Outcome
• Middle Aged
• Bone Density Conservation Agents/administration & dosage
• Bone Density Conservation Agents/therapeutic use
• Aged, 80 and over
• Rotator Cuff/surgery
• Bone Density/drug effects
• Administration, Intravenous

• 81772355 National Natural Science Foundation of China

• Humans
• Rotator Cuff Injuries/surgery
• Biological Products/therapeutic use
• Wound Healing/drug effects
• Rotator Cuff/surgery

• Cuff rerupture
• Functionality
• Long Head of the Biceps
• Old adults
• Rotator cuff repair
• Superior Capsular Reconstruction

• Humans
• Male
• Female
• Rotator Cuff Injuries/surgery
• Middle Aged
• Aged
• Pilot Projects
• Rotator Cuff/surgery
• Plastic Surgery Procedures/methods
• Treatment Outcome
• Adult
• Tendons/surgery

• atraumatic
• demographic trends
• rotator cuff tear
• traumatic
• young patients

• MRI scans
• Muscle atrophy
• Rotator cuff injuries
• Shoulder joint
• Tendinopathy

• Humans
• Female
• Male
• Adult
• Adolescent
• Young Adult
• Retrospective Studies
• Rotator Cuff Injuries/surgery
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/pathology
• Muscular Atrophy/pathology
• Muscular Atrophy/diagnostic imaging
• Muscular Atrophy/etiology
• Time Factors
• Magnetic Resonance Imaging
• Rotator Cuff/pathology
• Rotator Cuff/diagnostic imaging
• Rotator Cuff/surgery
• Arthroscopy/methods
• Tendon Injuries/diagnostic imaging
• Tendon Injuries/pathology
• Tendon Injuries/surgery

• Arthroscopy
• Geriatry
• Healing
• Rotator cuff
• Shoulder
• Supraspinatus

• Corticosteroid
• Intra-articular injection
• Intratendinous injection
• PRP
• Partial thickness rotator cuff tears
• Subacromial injection

• Delaminated rotator cuff tears
• En masse repair
• L‐shaped
• Separate repair
• Triple‐row

• Humans
• Arthroscopy/methods
• Rotator Cuff Injuries/surgery
• Male
• Middle Aged
• Female
• Aged
• Suture Techniques
• Retrospective Studies
• Pain Measurement

• Endurance
• Functional performance
• Pain
• Rotator cuff
• Scapula

• Computed tomography
• Magnetic resonance imaging
• Patch
• Primary irreparable rotator cuff tear
• Retear rate
• Site of retear

• Humans
• Aged
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/surgery
• Retrospective Studies
• Shoulder Joint/surgery
• Treatment Outcome
• Fascia
• Arthroscopy/methods
• Magnetic Resonance Imaging

• estrogen
• gene expression
• murine
• rotator cuff repair
• testosterone

• Humans
• Male
• Mice
• Animals
• Rotator Cuff/pathology
• Rotator Cuff Injuries/drug therapy
• Rotator Cuff Injuries/surgery
• Rotator Cuff Injuries/pathology
• Testosterone/pharmacology
• Testosterone/therapeutic use
• Tendons/surgery
• Estrogens/therapeutic use
• Estrogens/pharmacology
• Dietary Supplements
• Biomechanical Phenomena

• LS Peery Foundation Discovery Program in Musculoskeletal Restoration

• arthroscopic
• bone marrow stimulation
• meta-analysis
• repair
• shoulder

• Artificial intelligence
• ChatGPT
• Natural language processing
• Patient information
• Rotator cuff repair
• Shoulder

• Arthroscopy
• Complications
• Economics
• Failure
• Healthcare costs
• Reoperation
• Rotator cuff repair

• arthroscopic rotator cuff repair
• bone marrow stimulation
• glenohumeral osteoarthritis
• meta-analysis
• microfracture
• rotator cuff retear

• angiogenesis
• developmental processes
• extracellular matrix organization
• protein transport
• tissue morphogenesis

• bursa
• immune response
• muscle cell differentiation
• rotator cuff tendinopathy
• transcriptomics

• aging
• chondrogenesis
• enthesis
• rotator cuff
• tenogenesis

Platelet-rich plasma has been gaining popularity as an agent for biological augmentation either as the sole treatment modality or as an adjunct to surgical repair. There is substantial discrepancy in the results of the published meta-analyses; and the true efficacy and role of using autologous platelet-rich plasma (PRP) at the time of rotator cuff repair is still ambiguous.

To performed this systematic overview on the overlapping meta-analyses that analyzed autologous PRP as an adjuvant in the repair of rotator cuff tears and identify the studies which provide the current best evidence on this subject and generate recommendations for the same.

We conducted independent and duplicate electronic database searches in PubMed, Web of Science, Scopus, Embase, Cochrane Database of Systematic Reviews, Reference Citation Analysis and the Database of Abstracts of Reviews of Effects on September 8, 2021 to identify meta-analyses that analyzed the efficacy of PRP as an adjuvant in the repair of rotator cuff tears. Methodological quality assessment was made using Oxford Levels of Evidence, AMSTAR scoring and AMSTAR 2 grades. We then utilized the Jadad decision algorithm to identify the study with the highest quality to represent the current best evidence to generate the recommendation.

Twenty meta-analyses fulfilling the eligibility criteria were included. The AMSTAR scores of the included studies varied from 6-10 (mean: 7.9). All the included studies had critically low reliability in their summary of results due to their methodological flaws according to AMSTAR 2 grades. Significant heterogeneity was observed in the reporting of VAS, function outcome scores (long-term UCLA score, ASES score, SST score), operative time and long-term re-tear rates. Recent meta-analyses are more supportive of the role of intra-operative administration of PRPs at the bone-tendon interface in improving the overall healing and re-tear rates, functional outcome and pain. The initial size of the tear and type of repair performed do not seem to affect the benefit of PRPs. Among the different preparations used, leucocyte poor (LP)-PRP possibly offers the greatest benefit as a biological augment in these situations.

Based on this systematic overview, we give a level II recommendation that intra-operative use of PRPs at the bone-tendon interface can augment the healing rate, reduce re-tears, enhance functional outcome and mitigate pain in patients undergoing arthroscopic rotator cuff repair. LP-PRP possibly offers the greatest benefit in terms of healing rates, as compared with other platelet preparations.

• Platelet-rich plasma
• Rotator cuff tears
• Meta-analyses
• Functional outcome
• Re-tear
• Recommendation

• Cuff integrity
• Functional outcome
• Magnetic resonance imaging
• Rotator cuff
• Rotator cuff injuries
• Rotator cuff repair
• Shoulder

• Arthroscopy
• MRI
• Rotator cuff
• Shoulder
• Single-row repair

• Arthroscopy/methods
• Humans
• Magnetic Resonance Imaging
• Range of Motion, Articular
• Retrospective Studies
• Rotator Cuff/diagnostic imaging
• Rotator Cuff/surgery
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/surgery
• Treatment Outcome

Rotator cuff repair is a common orthopaedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions.

To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair.

Case series; Level of evidence, 4.

Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon’s insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests.

At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P = .01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P < .01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion.

Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function.

• arthroscopic rotator cuff repair
• failure with continuity
• repair failure
• rotator cuff
• shoulder

• Arthroscopic debridement
• Biceps tenotomy
• Irreparable rotator cuff tear
• Massive rotator cuff tear
• Shoulder arthroscopy
• Subacromial decompression
• Tuberoplasty

• Amnion
• Amniotic
• Biologic enhancement of rotator cuff
• Human amniotic membrane
• Matrix metalloproteinase
• Rotator cuff augmentation
• Rotator cuff healing

Understanding cell recruitment in damaged tendons is critical for improvements in regenerative therapy. We recently reported that targeted disruption of transforming growth factor beta (TGFβ) type II receptor in the tendon cell lineage (Tgfbr2^ScxCre) resulted in resident tenocyte dedifferentiation and tendon deterioration in postnatal stages. Here we extend the analysis and identify direct recruitment of stem/progenitor cells into the degenerative mutant tendons. Cre-mediated lineage tracing indicates that these cells are not derived from tendon-ensheathing tissues or from a Scleraxis-expressing lineage, and they turned on tendon markers only upon entering the mutant tendons. Through immunohistochemistry and inducible gene deletion, we further find that the recruited cells originated from a Sox9-expressing lineage and their recruitment was dependent on cell autonomous TGFβ signaling. The cells identified in this study thus differ from previous reports of cell recruitment into injured tendons and suggest a critical role for TGFβ signaling in cell recruitment, providing insights that may support improvements in tendon repair.

•

Targeted deletion of TGFβ signaling led to degenerative changes in mouse tendons

• Scleraxis
• ScxCre
• Sox9
• TGFβ signaling
• TGFβ type II receptor
• cell autonomous
• cell recruitment
• stem/progenitor cells
• tendon
• tendon degeneration

• Arthroscopy
• Double row
• Modified Mason–Allen
• Rotator cuff repair
• Rotator cuff tears
• Single row
• Suture bridge

• Arthroscopy/methods
• Humans
• Prospective Studies
• Retrospective Studies
• Rotator Cuff Injuries/surgery
• Suture Techniques
• Sutures
• Treatment Outcome

• Allograft
• Patch
• Revision
• Rotator cuff
• Shoulder arthroscopy

• Adipocyte accumulation
• Aging
• Collagen synthesis
• Ectopic ossification
• Tendon healing

To present an alternative arthroscopic rip-stop technique with a single suture tape weaved through the tendon from anterior to posterior and to biomechanically test its strength against a control technique consisting of a single-row repair with simple sutures.

This was a controlled biomechanical study. Dissection and harvesting of the supraspinatus muscle-tendon unit were performed along the cable in 9 matched-pair cadaveric shoulders. Samples were divided into 2 groups: simple suture repair only (SSR) and simple suture repair with rip-stop (SSPR). Biomechanical testing was performed with an initial preload, followed by cyclic loading and then ramp to failure. Peak-to-peak displacement, stiffness (in newtons per millimeter), load at failure (in newtons), and failure mechanism were recorded. Data were compared using the paired-sample t test.

The average peak-to-peak displacement for SSR samples was not significantly different from that of SSPR samples (P = .96). Similarly, elongation in the SSR and SSPR groups was not significantly different (P = .82). Stiffness was significantly different between the SSR and SSPR groups (P = .0054): SSR samples were less stiff than SSPR samples. Moreover, SSR samples failed at significantly lower forces than did SSPR samples (P = .028). A larger percentage of failures occurred due to tendon cut-through among SSR samples versus suture breakage among SSPR samples.

An alternative rip-stop technique is presented in this biomechanical model that may assist surgeons to better deal with difficult rotator cuff repairs. Weaving a suture tape as a rip-stop can increase stiffness, achieve higher failure loads when compared with simple suture repair with no rip-stop, and reduce tendon cut-through.

This study provides insight into a variation of rip-stop stitch techniques that may help solve the clinical problem of failure occurring at the suture-tendon interface, specifically tendon cut-through.

Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown.

To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR.

Case series; Level of evidence, 4.

A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system.

The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 (P < .0001) and 84.5 ± 9.4 (P < .0001) at final follow-up, respectively. The mean mediolateral tear size (P = .03, .02, and .02, respectively) and residual tendon attachment area (P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI (r = –0.81 to 0.78).

The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.

• arthroscopic rotator cuff repair
• functional outcome
• large/massive rotator cuff tears
• residual tendon attachment area
• retear
• structural outcome

The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function.

Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery.

There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01).

Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

• Arthroscopy
• PASTA lesion
• Repair
• Supraspinatus

• Bankart procedure
• SLAP repair
• arthroscopy
• biceps tenodesis
• cuff repair
• gymnasts

• bridging reconstruction
• dermal allograft
• interposition graft
• massive rotator cuff tear
• maximal repair
• patient-reported outcome

This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections for treatment of full-thickness rotator cuff tear (RCT).

Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 were enrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HA injection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery using the American Shoulder and Elbow Surgeons score, visual analog scale pain score , functional scores (pain visual analog scale, function visual analog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity.

Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05). However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than in group I (0%) (p=0.021).

Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thickness RCT.

• Atelocollagen
• Full-thickness tear
• Hyaluronic acid
• Rotator cuff
• Shoulder

• lncrna
• mirna
• tendon stem cell
• rotator cuff tear repair

• Animals
• Cell Differentiation/physiology
• MicroRNAs/metabolism
• RNA, Long Noncoding/metabolism
• Rats, Sprague-Dawley
• Rotator Cuff Injuries/metabolism
• Signal Transduction/physiology
• Stem Cells/physiology
• Tendons/cytology
• Tendons/metabolism
• Vascular Endothelial Growth Factor A/metabolism
• Rats

• arthroscopic surgery
• clinical trial
• double row
• long term
• randomized
• rotator cuff
• rotator cuff repair
• shoulder joint
• single row

Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear.

To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique. Our hypothesis was that the suture would pull out of the lateral anchor (suture slippage), changing the positions of the medial suture knots during healing.

Case series; Level of evidence, 4.

This study included 53 patients (55 shoulders) who underwent arthroscopic suture-bridge repair and were evaluated for a minimum of 24 months. On serial ultrasonography, a straight line was drawn between the top of the greater tuberosity and the medial cortex of the anchor hole. The distances between the knots of the medial rows and the perpendicular line through the center of the anchor hole were measured in longitudinal plane images of the supraspinatus. Follow-up ultrasonography was performed at 2, 3, and 6 months postoperatively as well as at the final visit. The visual analog scale, the American Shoulder and Elbow Surgeons score, the Constant score, and the University of California, Los Angeles shoulder score were recorded preoperatively and on the final follow-up.

Of the 55 shoulders, 6 developed retears at repaired sites. The mean follow-up duration was 37.5 months (range, 24-65 months). Slippage distance increased significantly over time (P < .001). The slippage at the final visit did not differ between patients with retear and no retear (13.4 mm for retear group; 10.6 mm for no retear group [P = .096]).

Suture knots of the medial row migrated medially via a suture pullout from the lateral row anchor of suture-bridge technique. Suture slippage distance did not differ significantly between retear and no retear groups.

• arthroscopic repair
• knot
• rotator cuff
• shoulder
• suture slippage

A rotator cuff tear is a common disabling shoulder problem. Symptoms include pain, weakness, lack of mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a pressing need to improve the outcome of rotator cuff surgery. The use of patch augmentation to provide support to the healing process and improve patient outcomes holds new promise. Different materials (e.g. human/animal skin or intestine tissue, and completely synthetic materials) and processes (e.g. woven or a mesh) have been used to produce patches. However, clinical evidence on their use is limited. The patch augmented rotator cuff surgery (PARCS) feasibility study aimed to determine the design of a definitive randomised controlled trial (RCT) assessing the effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible.

A mixed methods feasibility study of conducing a subsequent RCT. The project involved six stages: a systematic review of clinical evidence; a survey of the British Elbow and Shoulder Society’s (BESS) surgical membership; a survey of surgeon trialists; focus groups and interviews with stakeholders; a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting.

The BESS surgeons’ survey identified a variety of patches in use (105 (21%) responses received). Twenty-four surgeons (77%) completed the trialist survey relating to trial design. Four focus groups were conducted involving 24 stakeholders. Twenty-nine (67% of invited) individuals took part in the Delphi. Differing views were held on a number of aspects including the appropriate patient population for trial participation. Agreement on the key research questions and the outline of two potential RCTs were achieved through the Delphi study and the consensus meeting.

Randomised comparisons of on-lay patch use for completed rotator cuff repairs, and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. The main limitation was that the findings were influenced by the participants, who might not necessarily reflect all stakeholders.

• Dermal matrix
• Feasibility study
• Patch
• Randomised trial
• Rotator cuff tear
• Shoulder surgery
• Surgical mesh
• Tissue scaffold

Introduction: Rotator cuff tear with delamination is considered a risk factor for postoperative retear. The purpose of this study was to compare clinical outcomes between three repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and the combination of DLSB with modified Debyere-Patte (DLSB + DP). Methods: 53 shoulders of 52 patients who had massive rotator cuff tears with delamination were categorized into three groups: EMSB (18 shoulders), DLSB (24 shoulders), and DLSB + DP (11 shoulders). The mean postoperative follow-up period was 34.6 months. Pre- and postoperative evaluations included a range of motion (ROM), Constant scores, global fatty degeneration (GFDI), and tendon integrity according to Sugaya’s classification by magnetic resonance images (MRI). Results: In all groups, ROM significantly improved after the procedures. Mean constant scores significantly improved: from 45.5 to 77.4 after EMSB, from 45.5 to 87.6 after DLSB, and from 46.3 to 88.0 after DLSB + DP. Significant differences were noted in postoperative Constant scores (p = 0.018: DLSB vs. EMSB, and p = 0.045: DLSB + DP vs. EMSB). The Constant pain scores were better for DLSB + DP than for EMSB (p = 0.012). Global fatty degeneration index (GFDI) with DLSB + DP was significantly higher than that for either EMSB or DLSB, indicating significant preoperative fatty degeneration for DLSB + DP. Retear occurred in 27.8% of the EMSB group, 12.5% of the DLSB group, and 9.1% of the DLSB + DP group. Discussion: Comparisons of the three groups demonstrated that DLSB and DLSB + DP achieved better clinical outcomes than EMSB for the repair of large or massive rotator cuff tears. DLSB + DP is useful for massive rotator cuff tears with severe fatty degeneration or for cases where the presence of excessive tension is anticipated when repairing the torn cuff.

• Delamination
• Double-layer repair
• En masse repair
• Rotator cuff tear
• Suture-bridge

• Chronic rotator cuff tear
• Fatty degeneration
• Polydeoxyribonucleotide
• Polynucleotide
• Rat model
• Tendon healing

• 7 Tesla
• T2 relaxation times
• surgical re-attachment
• tendon