Cofield, J Bone Joint Surg Am 1985 - Rotator Cuff Disease of the Shoulder

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Rotator Cuff Disease of the Shoulder

Cofield·J Bone Joint Surg Am·1985·566 citations·Review article

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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.

Key Findings

The rotator cuff provides one-third to one-half of abduction power and at least 80% of external rotation power — making the cuff functionally dominant over the deltoid for rotation tasks, not just a stabilizer.
Non-operative treatment of arthrographically confirmed full-thickness tears succeeds in 50% or fewer patients.
- Takagishi's arthrography-verified series: only 44% recovery, mostly in small tears.
- Older 80-90% success figures came from series without arthrographic confirmation. Those numbers are unreliable.
For acute full-thickness tears with loss of abduction, timing of repair drives functional recovery:
- Within 3 weeks: best return of motion and strength
- 3-6 weeks: already inferior
- 6+ weeks: outcomes parallel chronic repair
- Pain relief is satisfactory at any point within 3 months. But function is time-sensitive.
Pooled surgical results across the literature:
- Pain relief: 87% (range 71-100%)
- Patient satisfaction: 77% (range 72-82%)
- Excellent/good results: 85% (range 65-100%)
- Wide ranges reflect heterogeneous tear sizes. Not all repairs are equal.
Revision repair after failed initial repair reduces pain in ~75% of patients but rarely restores strength or motion. The second repair is a salvage operation. Getting the first repair right is non-negotiable.

Board PearlArthrographically confirmed full-thickness rotator cuff tears succeed with non-operative treatment in 50% or fewer patients — not the 80-90% cited in older unverified series.

Rotator Cuff Disease of the Shoulder.

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Rotator Cuff Disease of the Shoulder

Cofield·J Bone Joint Surg Am·1985·566 citations·Review article

|

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.

Key Findings

The rotator cuff provides one-third to one-half of abduction power and at least 80% of external rotation power — making the cuff functionally dominant over the deltoid for rotation tasks, not just a stabilizer.
Non-operative treatment of arthrographically confirmed full-thickness tears succeeds in 50% or fewer patients.
- Takagishi's arthrography-verified series: only 44% recovery, mostly in small tears.
- Older 80-90% success figures came from series without arthrographic confirmation. Those numbers are unreliable.
For acute full-thickness tears with loss of abduction, timing of repair drives functional recovery:
- Within 3 weeks: best return of motion and strength
- 3-6 weeks: already inferior
- 6+ weeks: outcomes parallel chronic repair
- Pain relief is satisfactory at any point within 3 months. But function is time-sensitive.
Pooled surgical results across the literature:
- Pain relief: 87% (range 71-100%)
- Patient satisfaction: 77% (range 72-82%)
- Excellent/good results: 85% (range 65-100%)
- Wide ranges reflect heterogeneous tear sizes. Not all repairs are equal.
Revision repair after failed initial repair reduces pain in ~75% of patients but rarely restores strength or motion. The second repair is a salvage operation. Getting the first repair right is non-negotiable.

Board PearlArthrographically confirmed full-thickness rotator cuff tears succeed with non-operative treatment in 50% or fewer patients — not the 80-90% cited in older unverified series.

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