Biology of Rotator Cuff Healing
Rotator cuff tears are the most common source of shoulder pain and dysfunction in adults worldwide. It is estimated that 30–40% of the current population over the age of 60 will suffer a full-thickness rotator cuff tear [1]. Due to the enormity of this po
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Hunter Hood and Felix H. Savoie III
15.1 Introduction
cate the matter, studies that compare healing with patient outcomes do not always identify a direct Rotator cuff tears are the most common source of correlation between the former and the latter [3]. shoulder pain and dysfunction in adults world- The next great milestone in the treatment of rotawide. It is estimated that 30–40% of the current tor cuff tendon tears will likely be the amalgamapopulation over the age of 60 will suffer a full- tion of a greater understanding of the complexities thickness rotator cuff tear [1]. Due to the enor- of rotator cuff healing with the vast array of curmity of this population, significant research rent data regarding preoperative, surgical, and efforts have been undertaken to identify strate- postoperative management. The goal for this gies for prevention, treatment, and rehabilitation chapter is to present a concise review of the biolof rotator cuff tears. The rate of recurrence of ogy of the rotator cuff, factors that affect patholrotator cuff tears, estimated to range from 5% to ogy and healing, and clinical interventions that 85%, is also a significant factor to consider when optimize both healing and functional outcome. assessing the overall burden that these injuries impart upon healthcare systems. The majority of recurrent tears occur in the first 3 months follow- 15.2 Native Biology ing primary repair, and this high rate of recurrence is primarily attributed to poor healing [2]. The rotator cuff is a complex of flat tendons, Despite ever-improving biomechanics of fixa- comprised of the supraspinatus, infraspinatus, tion, biological failure following rotator cuff teres minor, and subscapularis tendons. Like repair remains a significant burden on healthcare other tendons, the primary composition of each systems worldwide. rotator cuff tendon is water (55% wet weight) Research efforts that evaluate aspects of rota- and type I collagen (85% dry weight). The tor cuff tear pathology and treatment range from described triple helical arrangement of collagen studies of microscopic molecular signals that with cross-linking is crucial to the mechanical affect tendon healing to macroscopic analyses of strength of the tissue and its ability to facilitate surgical techniques that yield superior healing tensile loads. The proteoglycan component of the and improved functional outcomes. To compli- tendon structure plays an important role in establishing the viscoelastic properties necessary for normal motion. Tenocytes function to establish H. Hood (*) · F. H. Savoie III (*) Orthopaedic Surgery, Tulane University School the extracellular matrix while also synthesizing of Medicine, New Orleans, LA, USA collagen and proteoglycans to maintain structure e-mail: [email protected]; [email protected]
© ISAKOS 2019 A. B. Imhoff, F. H. Savoie III (eds.), Rotator Cuff Across the Life Span, https://doi.org/10.1007/978-3-662-58729-4_15
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[4, 5]. Tenocytes have been shown to respond to mechanical loading and regulate chemotactic
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