This prospective cohort study evaluated 18 patients who underwent complete arthroscopic repair of large and massive rotator cuff tears (>2 cm transverse dimension). Repair integrity was assessed by validated ultrasound at 12 and 24 months. The study asked whether structural healing is necessary for good functional outcomes.
The 94% re-tear rate in this paper is the most cited number in massive rotator cuff repair counseling — and it fundamentally changed how surgeons set expectations. When a patient with a large or massive tear asks whether the repair will hold, the honest answer is: structurally, probably not. But pain relief and function often improve substantially in the first year regardless.
The critical nuance is the two-year trajectory. Scores, elevation, and pain all worsen between 12 and 24 months. When you counsel these patients preoperatively, frame surgery as providing likely pain relief and functional improvement, with the realistic possibility of declining results over time. Not a durable structural fix.
This paper is also why we preserve the coracoacromial arch in structurally tenuous repairs: loss of this restraint risks anterosuperior escape of the humeral head when the cuff fails.
For younger patients where long-term strength is the priority, the authors themselves argue that arthroscopic repair may not be the best choice. A pearl worth remembering when a 45-year-old with a massive tear sits across from you in clinic.
This prospective cohort study evaluated 18 patients who underwent complete arthroscopic repair of large and massive rotator cuff tears (>2 cm transverse dimension). Repair integrity was assessed by validated ultrasound at 12 and 24 months. The study asked whether structural healing is necessary for good functional outcomes.
The 94% re-tear rate in this paper is the most cited number in massive rotator cuff repair counseling — and it fundamentally changed how surgeons set expectations. When a patient with a large or massive tear asks whether the repair will hold, the honest answer is: structurally, probably not. But pain relief and function often improve substantially in the first year regardless.
The critical nuance is the two-year trajectory. Scores, elevation, and pain all worsen between 12 and 24 months. When you counsel these patients preoperatively, frame surgery as providing likely pain relief and functional improvement, with the realistic possibility of declining results over time. Not a durable structural fix.
This paper is also why we preserve the coracoacromial arch in structurally tenuous repairs: loss of this restraint risks anterosuperior escape of the humeral head when the cuff fails.
For younger patients where long-term strength is the priority, the authors themselves argue that arthroscopic repair may not be the best choice. A pearl worth remembering when a 45-year-old with a massive tear sits across from you in clinic.