Editorial Commentary: Repairing Retracted Rotator Cuff Tears: Histologically Different, but Success Still Achievable With "Failure in Continuity".

Abstract

Failure after rotator cuff repair continues to occur despite advances in our understanding of the native tendon enthesis. Recurrent postoperative tendon defects are common, and the impact of nonhealing on postoperative outcomes remains controversial. Rotator cuff tears (RCT) of all patterns commonly present with some degree of retraction, and it is, therefore, critical to understand and examine the biology and biomechanics of the retracted RCT to address why a repaired tendon may fail. An article in this issue reports on retracted tears forming more disorganized fibrous tissue with similar biomechanical properties compared to nonretracted tear tissue. It provides insight into what lies "beneath the surface" after retracted rotator cuff repair, but it is unclear whether the fibrous tissue formed after their acute partial tendon excision adequately reflects the tissue found in more chronic, retracted human rotator cuff tears, particularly with varying degrees of retraction. Facilitating a more favorable "scar-forming" environment and optimizing this postoperative fibrous tissue may be crucial to improving rotator cuff repairs in the future.