arthroscopic rotator cuff repair

How to Enhance Your Success After Rotator Cuff Repair Surgery

Rotator cuff tears are very common injuries for people of all ages, even though our ability to evaluate and treat shoulder impingement has improved..  Depending on the study you read, it has been reported that 13% of people over the age of 50 years and 50% of people over the age of 80 years will have a rotator cuff tear.  Naturally, rotator cuff repair surgery has become equally as common.  Over the last several decades we have made great progress in our rotator cuff repair surgical techniques, transitioning from an open procedure, to a less invasive “mini-open” procedure, and now full arthroscopic.

arthroscopic rotator cuff repairThe newer arthroscopic rotator cuff repairs tend to less painful and allow people to do more sooner.  However, one mild little fact that we often do not hear about is that the failure rate after rotator cuff repair surgery is still too high.

Past studies have shown up to 75% of people following a rotator cuff repair will technically “fail” if you define surgical failure as the cuff is not intact again after surgery.  A recent systematic review published in JOSPT reported a failure rate between 18% and 40% over 10 different research reports.

Despite these “failure” rates, most research studies have shown that patient satisfaction after surgery is still very high.  This tells me that the rehabilitation process may be far more important than the actual surgery.  That is great news, even if the rotator cuff is found to not be intact again after surgery, pain, motion, strength, function, and satisfaction can all still be improved significantly.

Regardless, we should all be doing everything we can to maximize your success after rotator cuff repair surgery.

A recent systematic literature review publish in JOSPT sought to determine the prognostic factors associated with a successful recover following arthroscopic rotator cuff repair surgery.  Based on this paper, we can identify several factors that can help maximize your outcomes following surgery.  While, not all of these factors are easily addressed, many are, and it is always my goal to assure you put yourself in the best position to succeed.

Factors Associated with Successful Recovery Following Rotator Cuff Repair

The review focused on 10 papers that met the authors’ strict guidelines for inclusion.  Based on these 10 papers, they were able to identify 12 factors that were correlated to better outcomes following rotator cuff repair surgery.  These 12 factors were divided into 4 categories: demographic factors, clinical factors, factors related to the rotator cuff integrity, and factors related to the surgical procedure.

I am going to discuss the first 3 as they relate to things we may be able (or not able) to do to enhance outcomes following rotator cuff surgery.  In regard to surgical factors, one study showed that performing additional procedures to the biceps or acromioclavicular joint was associated with poorer outcomes.  We can’t really control the surgical procedures, but perhaps this information may be beneficial to the surgeons.

Demographic Factors

The most significant finding in regard to general demographics was related to patient age at the time of surgery.  Older age had a negative effect on recovery.

The studies demonstrated that the older you are, the less your chance of tendon healing.  Those under the age of 55 years have the best outcomes with between 88-95% chance of tendon healing.  In contrast, people aged over 60 years had between 43-65% chance of tendon healing.

While you can’t control when your rotator cuff becomes troublesome, these results do imply that we should not ignore symptoms and allow your shoulder and rotator cuff to gradually become more degenerative.  Addressing issues earlier should help with outcomes.  We have all seen it, most people put off addressing their shoulder soreness for years, attempting to work through the discomfort.  We don’t usually seek help until our functional level is significantly impaired.

Clinical Factors

Not surprising, bone mineral density and diabetes were both associated with poorer tissue healing.  Obesity was also associated with less successful outcomes.  People that were considered obese had a 12% less chance of successful outcomes.

I thought a very interesting finding involved your activity level prior to surgery.  People who rarely participated in physical activities had poorer outcomes that those that participated in medium- and high-intensity sports, such as golf, swimming, cycling, running, and tennis.

In regard to strength and motion, it was determined that the best predictor of final strength was initial strength.  Preoperative should stiffness also had a negative effect on recovery time, delaying return to activity.

While some of these factors, like bone mineral density and diabetes, may not be avoided, you can assure that these are under control medically before surgery.  However, factors such as obesity, activity level, strength, and mobility are all likely related and can be addressed prior to surgery.  This underscores the importance of performing physical therapy PRIOR to surgery.  I always say, the better you look going into the surgery, the better you’ll look coming out of surgery.

Rotator Cuff Integrity Factors

rotator cuff tear retractionThere were 4 factors in regard to the integrity of the rotator cuff that related to poor outcomes: tear size, the number of rotator cuff muscles involved, the amount of tendon retraction, and the amount of fatty infiltration.  These factors are all associated with tissue degeneration, and perhaps even associated with age.

Essentially, the more degenerative the tissue, the worse the outcomes.  Over time, your cuff tear will progress in size, potentially start to pull off the bone (retract), and become weak.

These factors are probably more associated with my comments on age above.  Perhaps we should be more proactive with our decisions regarding taking care of our shoulders prior to the tear becoming more involved and the tissue more degenerative.  Something to consider, repair of a small rotator cuff tear had a 96.7% chance of healing after surgery in comparison to a 58.8% chance if that tear becomes large.

What You Can Do to Enhance Outcome Following Rotator Cuff Repair Surgery

I feel like this study shed some light on several things we can do to enhance your outcomes following rotator cuff repair surgery:

  • First we should do our best at evaluating shoulder impingement, and then treating shoulder impingement symptoms to try to minimize a rotator cuff tear in the future.
  • Do not unnecessarily put off surgery as outcomes are less successful the older you are at the time of surgery.
  • In regard to the above, also consider that putting off surgery may allow the rotator cuff to become degenerative.  The larger the tear and the more degenerative the tissue, the less successful the outcome.
  • Being physically active and losing weight are both associated with better outcomes.  Get off your butt.
  • Begin physical therapy prior to surgery.  The stronger and more mobile your shoulder is at the time of surgery, the better off you’ll be after surgery.  You’ll be stronger and return to activities sooner.  Plus, some studies have shown that physical therapy can help you avoid rotator cuff surgery.
  • Assure that medical conditions, such as bone mineral density and diabetes, are being addressed and under control prior to surgery.

For the clinicians reading this, we can also use this information to determine our rate of progression during rotator cuff repair rehabilitation.  The more prognostic factors that your patient may have indicating a less successful outcome, the more conservative you may need to progress.

Would you progress some that is a 52 years old physical active person with a small rotator cuff tear and no other health issues at the same pace as a 74 year old with a large tear, weakness, and diabetes?  Of course not.  We can’t just blindly follow a protocol.  Protocols are useful and necessary, but they just provide structure that you adjust if factors dictate that you should be more conservative.

There are ways to enhance your success after rotator cuff repair surgery, many of which are controllable.  Use these findings to help you or your client’s maximize your outcomes following surgery.

13 replies
  1. Evercore Physical Therapy
    Evercore Physical Therapy says:

    I agree that rehab and prehab for rotator cuff tears will depend on factors like the size of the tear and the age of the individual. I saw a 70-year-old client today who likely has a rotator cuff tear and advanced arthritis with crepitus. His doctor suggested he may need surgery, but they both want to avoid surgery at his age. He is starting physical therapy with me to reduce his shoulder pain and restore as much function as possible without surgery so this article is a helpful reminder to be conservative and manage the tear appropriately. – Dr. Marc Robinson, PT, DPT, Cert. MDT.

    • Mike Reinold
      Mike Reinold says:

      I’ve had some luck with those Marc, just get as much of the remaining anterior/posterior cuff strong and it may be able to work well enough for their activity level.

  2. Pat P.
    Pat P. says:

    Just had arthroscopic rotator cuff surgery on a full thickness tear on 2/15. My doctor held me off from PT for 6 weeks to allow for tendon to heal back to the bone. I am doing great. I am a 59 year old active female-play golf swim, walk, work out in the garden etc. Yes, it was rough for the first couple of weeks but, there is light at the end of the tunnel. It took me from 10/16 to 2/15/17 to have the surgery for reasons not in my control.

  3. BDBinc
    BDBinc says:

    Hi Mike

    Do you think the person’s state of mind, their attitude or their diet can effect their body’s healing?

  4. Reboundwear Marketing
    Reboundwear Marketing says:

    My son has just gone in for rotator cuff surgery a week ago. He is young, but had been suffering a lot. Due to the pain and nothing else working, he had surgery. We are hoping that because of all the factors stated above he will recovery without any issues. Because of him and many other family members suffering surgery, we started making adaptive wear clothing. We hoped that it would facilitate those in need or with limited movement. We wish you all a speedy recovery and to those going into surgery we wish you all the best of luck.

  5. Patty Gaugler
    Patty Gaugler says:

    Im schedualed for rotator cuff surgery on April 12. The Dr specializes in shoulder and elbow surgery. I am 75, female. I’m very concerned but really no choice. The pain is excruciating. WILL…did the Dr’s say why 3 failed surgeries ??? What about the shoulder surgery ? Please email me at [email protected]. Thanks and good luck.

  6. will
    will says:

    I’ve had three unsuccessful rotator cuff surgeries. Total physical therapy visits were over 200. Three different surgeons. I did everything I was told to do. Don’t do it unless there’s no other option.

    • Patty Gaugler
      Patty Gaugler says:

      Ruchi, how are you coming along with your post op. Surgery ? Please let me know, my email is above. Thanks, patty

  7. Aileen Sherrin Hanson
    Aileen Sherrin Hanson says:

    Ditto…. I had an injury to my L shoulder which a well respected ortho MD advised surgery for. I knew my bio mechanics were poor since the injury, poor scapulo-thoracic control as this was severely damaged with the injury. 2 years later I am finally seeing improved scapula control and voila hardly any symptoms. Without first addressing the bio mechanics I feel patients are set up for failure/less than optimal function. Too many times people are rushed into surgery when the injury can be managed conservatively. Like the VOMIT reference, so true.

  8. Stephen Thomas, PhD, ATC
    Stephen Thomas, PhD, ATC says:


    Nice post. I agree prehab will make a huge difference. The other issue is overuse. Many people develop RCT from overuse and then return to overuse because they have too (construction workers). We have found that returning to overuse causes degeneration in the remaining intact rotator cuff tendons and also the glenoid cartilage (, I know this is in rats but it is the best way to conduct very controlled research. We also found that two tendon tears will affect the anterior-posterior force balance which can greatly affect the effects on the joint if left untreated ( The interesting thing we found was that with a tear of the supra and infra detaching the biceps actually prevent the degeneration of the remaining tendons ( Going back to your post I would highly recommend repairing a two tendon RCT due to the unbalance of anterior-posterior forces. Even a partial repair will greatly improve outcomes ( Also if they want to return to overuse it would be beneficial to repair single tendon tears. Finally in the case of an unrepairable two tendon RCT it seems that detaching the biceps can decrease the amount of joint damage. Clinical follow-ups are still needed but I think these results really help us with clinical decision making.

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