The biology of rotator cuff healing.

Zumstein, MA; Lädermann, A; Raniga, S; Schär, Michael (2017). The biology of rotator cuff healing. Orthopaedics & traumatology, surgery & research, 103(1), S1-S10. Elsevier 10.1016/j.otsr.2016.11.003

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Despite advances in surgical reconstruction of chronic rotator cuff (RC) tears leading to improved clinical outcomes, failure rates of 13-94% have been reported. Reasons for this rather high failure rate include compromised healing at the bone-tendon interface, as well as the musculo-tendinous changes that occur after RC tears, namely retraction and muscle atrophy, as well as fatty infiltration. Significant research efforts have focused on gaining a better understanding of these pathological changes in order to design effective therapeutic solutions. Biological augmentation, including the application of different growth factors, platelet concentrates, cells, scaffolds and various drugs, or a combination of the above have been studied. It is important to note that instead of a physiological enthesis, an abundance of scar tissue is formed. Even though cytokines have demonstrated the potential to improve rotator cuff healing in animal models, there is little information about the correct concentration and timing of the more than 1500 cytokines that interact during the healing process. There is only minimal evidence that platelet concentrates may lead to improvement in radiographic, but not clinical outcome. Using stem cells to biologically augment the reconstruction of the tears might have a great potential since these cells can differentiate into various cell types that are integral for healing. However, further studies are necessary to understand how to enhance the potential of these stem cells in a safe and efficient way. This article intends to give an overview of the biological augmentation options found in the literature.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Zumstein, Matthias, Schär, Michael


600 Technology > 610 Medicine & health








Lilianna Bolliger

Date Deposited:

07 Feb 2017 08:49

Last Modified:

05 Dec 2022 15:02

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Atrophy; Biological augmentation; Fatty infiltration; Growth factors; Mesenchymal stem cells; Platelet concentrates; Platelet-rich fibrin; Retraction; Rotator cuff healing; Scaffolds; Shoulder surgery; Stem cells




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