Harryman et al. followed 105 rotator cuff repairs in 89 patients at average 5-year follow-up, using blinded ultrasonography to assess structural integrity. The central question: does postoperative cuff healing — not the original tear size — determine how well a patient actually functions? All functional assessments were performed by an independent examiner blinded to operative and sonographic findings.
The prevailing assumption before this paper was that original tear size determined surgical prognosis — that massive tears were inherently bad operations with poor functional ceilings.
Harryman reframed the entire conversation: what matters is whether the repair holds, not how big the hole was. When counseling a patient with a large or massive tear, use this data directly. The re-tear risk is real (fewer than 1 in 3 three-tendon repairs remain intact), but a healed repair of a large tear will function as well as a healed repair of a small one.
Conversely, a re-tear does not mean the operation failed. 87% of patients with recurrent defects were still satisfied, and pain relief exceeded 70% even without structural integrity. Partly because all repairs included anterior-inferior acromioplasty.
For revision cases, the 58% re-tear rate warrants honest preoperative counseling, but it does not preclude surgery: a healed revision repair performs as well as a healed primary. This paper is the foundation for why we counsel patients that structural and symptomatic outcomes are not the same thing.
Harryman et al. followed 105 rotator cuff repairs in 89 patients at average 5-year follow-up, using blinded ultrasonography to assess structural integrity. The central question: does postoperative cuff healing — not the original tear size — determine how well a patient actually functions? All functional assessments were performed by an independent examiner blinded to operative and sonographic findings.
The prevailing assumption before this paper was that original tear size determined surgical prognosis — that massive tears were inherently bad operations with poor functional ceilings.
Harryman reframed the entire conversation: what matters is whether the repair holds, not how big the hole was. When counseling a patient with a large or massive tear, use this data directly. The re-tear risk is real (fewer than 1 in 3 three-tendon repairs remain intact), but a healed repair of a large tear will function as well as a healed repair of a small one.
Conversely, a re-tear does not mean the operation failed. 87% of patients with recurrent defects were still satisfied, and pain relief exceeded 70% even without structural integrity. Partly because all repairs included anterior-inferior acromioplasty.
For revision cases, the 58% re-tear rate warrants honest preoperative counseling, but it does not preclude surgery: a healed revision repair performs as well as a healed primary. This paper is the foundation for why we counsel patients that structural and symptomatic outcomes are not the same thing.