Technical pearls on how to maximize healing of the rotator cuff.

Rotator cuff tears are common in today's aging population. Repair of the torn rotator cuff tendon can be performed by a variety of methods including open, mini-open, and arthroscopic techniques. Many surgical and nonsurgical factors affect whether a tendon will successfully heal to the tuberosity after repair. A high rate of failure of healing of the tendon to the tuberosity occurs even in procedures performed by experienced surgeons. Patients who have retears after rotator cuff repair still have improvement in pain and function; however, outcomes are not as favorable compared with those of patients who have intact cuffs after surgery. Patient age, size and chronicity of the tear, and muscle degeneration and atrophy are major factors that affect successful healing of the rotator cuff. Surgical factors include proper surgical technique, tear pattern recognition, adequate subacromial decompression, cuff mobilization, preparation of the tuberosity, suture and knot tying technique, anchor placement, and surgeon experience. A proper postoperative rehabilitation regimen is also important to protect the repair during the first 12 weeks of tendon healing. Progress continues in developing grafts and growth factors to stimulate and enhance the patient's intrinsic healing potential and to reinforce the surgical repair. The future of rotator cuff repair may also involve gene therapy and supplementation with growth factors to improve the healing rates of surgically repaired rotator cuff tendons.