Cofield's 1985 Current Concepts Review surveys rotator cuff disease from pathogenesis through failed repair. It asks when surgery is necessary, how it should be done, and what to expect when it fails. The paper synthesized evidence challenging the then-prevailing assumption that most full-thickness tears resolve without surgery.
The 80-90% non-operative success rates cited before this paper came from series that never confirmed the tear with arthrography. When Takagishi actually verified full-thickness tears, the real success rate dropped to 44%.
This distinction matters every time you have a patient with a confirmed full-thickness tear on MRI who still has weakness and limited motion after several months of therapy. That patient is in the failing 50% — not a candidate for another three months of conservative care.
When a patient cannot abduct after a discrete injury and imaging confirms a full-thickness tear, the 3-week window is real. Pain will resolve with repair at any point in the first three months, but motion and strength recovery are meaningfully better with early repair. For an active patient, do not wait.
Revision repair is a pain operation, not a function operation. Counsel patients before a second surgery that roughly 75% will get some pain reduction, but expect minimal improvement in strength or range of motion. Use this to reinforce why meticulous technique at the index repair is the single most important variable you control.
Cofield's 1985 Current Concepts Review surveys rotator cuff disease from pathogenesis through failed repair. It asks when surgery is necessary, how it should be done, and what to expect when it fails. The paper synthesized evidence challenging the then-prevailing assumption that most full-thickness tears resolve without surgery.
The 80-90% non-operative success rates cited before this paper came from series that never confirmed the tear with arthrography. When Takagishi actually verified full-thickness tears, the real success rate dropped to 44%.
This distinction matters every time you have a patient with a confirmed full-thickness tear on MRI who still has weakness and limited motion after several months of therapy. That patient is in the failing 50% — not a candidate for another three months of conservative care.
When a patient cannot abduct after a discrete injury and imaging confirms a full-thickness tear, the 3-week window is real. Pain will resolve with repair at any point in the first three months, but motion and strength recovery are meaningfully better with early repair. For an active patient, do not wait.
Revision repair is a pain operation, not a function operation. Counsel patients before a second surgery that roughly 75% will get some pain reduction, but expect minimal improvement in strength or range of motion. Use this to reinforce why meticulous technique at the index repair is the single most important variable you control.