Search Results (32)

Background and Objectives: It is crucial to determine physical findings and outcome measures that affect functional status of the patients, and the impact levels of these parameters on patients. Therefore, the aim of this study was to investigate the determinant and predictive effect of pain levels, shoulder range of motion (ROM) values, disability and health-related quality of life factors on functional status in individuals with partial-thickness rotator cuff tears (PRCT). Materials and Methods: Firstly, the functional status of 45 patients (mean age: 50.78 ± 5.28 years; 29 female) with PRCT, then activity and night pain levels with Numeric Pain Rating Scale, active flexion, abduction and external rotation of the shoulder ROM values with goniometer, disability level with Quick Disabilities of Arm, Shoulder & Hand Questionnaire, and health-related quality of life levels with Short Form-12 were evaluated and recorded. Results: It was detected that all determinants whose effect on functionality was evaluated with a multiple regression model explained 76% of the variance, and this effect level was statistically significant (R square = 0.760, adjusted R square = 0.707, F = 14.272, p < 0.001). Detailed evaluation showed that flexion and external rotation ROM values (respectively; β = 0.54, p < 0.001; β = 0.38, p = 0.001) and disability level (β = 0.44, p < 0.001) had statistically significant determinant effects on functional status. No statistically significant results which could be correlated with functional status were found for activity and night pain, abduction ROM value, and health-related quality of life domains (p > 0.05). Conclusions: Shoulder flexion and external rotation ROMs and disability level were found to have a predictive effect on the functional status in individuals with PRCT. It is noteworthy that more subjective and patient-reported findings and outcome measures such as pain and health-related quality of life had no predictive effect on functionality. By determining the level of these effects, results were reached that can shed light on the literature by guiding the development of reliable assessment algorithms. Full article

Background/Objectives: Rotator cuff tears (RCTs) are a leading cause of shoulder pain and disability. Management typically involves conservative measures, such as physical therapy and anti-inflammatory medications, or surgery for full-thickness or refractory tears. Regenerative medicine therapies, including platelet-rich plasma (PRP), platelet lysate (PL), and mesenchymal stem cells (MSCs), show promise as alternative treatment strategies, although long-term outcomes remain under investigation. Methods: This cohort included 30 patients with partial rotator cuff tears and were treated with culture-expanded MSC injections. There was no control group. Inclusion criteria included an imaging-confirmed diagnosis of partial-thickness rotator cuff tears. Outcomes were assessed at multiple time points up to 6 years. Pain and function were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH), a Numeric Rating Scale (NRS), and the modified Single Assessment Numeric Evaluation (SANE). Results: Thirty patients (37 shoulders) were included in the analysis. Significant improvements in the NRS and DASH scores were observed at 3, 6, 12, 18, and 24 months (p < 0.01). Twenty-four months post-treatment, the mean NRS and DASH decreased by 2.25 and 15.93 points, respectively, and SANE improved by 60%. At six years, among seven respondents, the mean SANE improvement was 75.54%. During this study, no significant adverse events were reported. Conclusions: This study provides the longest known follow-up of MSC therapy for partial-thickness RCTs, finding sustained pain and functional improvements. The findings support further research into MSC-based and combination regenerative therapies as a viable alternative treatment option for partial-thickness rotator cuff tears. Full article

Background/Objectives: Diagnosing Rotator Cuff Tears (RCTs) via Magnetic Resonance Imaging (MRI) is clinically challenging due to complex 3D anatomy and significant interobserver variability. Traditional slice-centric Convolutional Neural Networks (CNNs) often fail to capture the necessary volumetric context for accurate grading. This study aims to develop and validate the Patient-Aware Vision Transformer (Pa-ViT), an explainable deep-learning framework designed for the automated, patient-level classification of RCTs (Normal, Partial-Thickness, and Full-Thickness). Methods: A large-scale retrospective dataset comprising 2447 T2-weighted coronal shoulder MRI examinations was utilized. The proposed Pa-ViT framework employs a Vision Transformer (ViT-Base) backbone within a Weakly-Supervised Multiple Instance Learning (MIL) paradigm to aggregate slice-level semantic features into a unified patient diagnosis. The model was trained using a weighted cross-entropy loss to address class imbalance and was benchmarked against widely used CNN architectures and traditional machine-learning classifiers. Results: The Pa-ViT model achieved a high overall accuracy of 91% and a macro-averaged F1-score of 0.91, significantly outperforming the standard VGG-16 baseline (87%). Notably, the model demonstrated superior discriminative power for the challenging Partial-Thickness Tear class (ROC AUC: 0.903). Furthermore, Attention Rollout visualizations confirmed the model’s reliance on genuine anatomical features, such as the supraspinatus footprint, rather than artifacts. Conclusions: By effectively modeling long-range dependencies, the Pa-ViT framework provides a robust alternative to traditional CNNs. It offers a clinically viable, explainable decision support tool that enhances diagnostic sensitivity, particularly for subtle partial-thickness tears. Full article

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. Full article

Background/Objectives: Bioinductive bovine collagen implants (BCI) have been introduced to enhance tendon biology and promote tissue regeneration in rotator cuff (RC) repairs. This study aimed to assess the clinical and radiological outcomes of arthroscopic posterosuperior rotator cuff (psRC) repair with BCI augmentation in full-thickness tears at increased risk of retear. Methods: This case series analyzed 30 patients with psRC tears who were classified as being at high risk of failure according to a predefined set of parameters, including patient history, radiological findings and intraoperative assessments, and the presence of psRC retears. All patients subsequently underwent arthroscopic psRC repair with BCI augmentation, compromising 21 primary and 9 secondary repairs. Clinical outcomes were assessed using Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) shoulder score, and Constant score at 6 and 12 months postoperatively. Tendon integrity was assessed using the Sugaya classification. Results: At 12 months, magnetic resonance imaging revealed complete tendon healing in 56.7%, partial healing in 16.7%, and insufficient healing in 26.7%. Significant improvements in SSV (45.3 to 83.5), ASES (40.6 to 77.8), and Constant score (36.6 to 71.7) were observed at 12 months postoperatively, with all outcome measures exceeding their respective minimally clinically important differences. Two patients (6.7%) developed secondary shoulder stiffness, and 1 patient (3.3%) required revision surgery for bicipital groove pain. Conclusions: Augmentation with a BCI in arthroscopic repair of high-risk psRC tears demonstrate promising short-term results. Patients achieve significant improvements in pain and shoulder function, accompanied by satisfactory tendon healing on MRI. Full article

Background: Cuff reconstructions vary due to different technical approaches by suture anchor manufacturers, as well as different suture construct configurations. Objectives: The main aim of this study is to primarily compare clinical outcomes and secondarily observe cost-effectiveness by assessing suture construct configurations in arthroscopic rotator cuff repair (ARCR). Methods: Using a retrospective local registry, we included patients undergoing arthroscopic rotator cuff repair who had been implanted with different anchor configurations and different anchor manufacturers. Data analysis was conducted via multiple linear regression, primarily evaluating the relationship between clinical scores (OSS; SSV) and suture construct configurations, to analyze, monitor, and compare the postoperative clinical development. Total surgical costs were also obtained from the clinical billing department for analysis of various factors, including Adjusted Life Years (ALYs) and Incremental Cost-Effectiveness Ratio (ICER), while controlling for sex, tear severity, and age. Results: A total of 317 patients were included in the final analysis, with a mean age at surgery of 60.1 ± 10.8 years, with 58% of patients being male. According to the Gerber tear severity classification, 23% of patients had a partial tear, 59% had at least one full-thickness tear, and the remaining 18% had a massive tear. Using linear regression models, the analysis of changes in Quality-Adjusted Life Years (QALYs) as the dependent variable did not yield statistically significant results. The postoperative development of the measured clinical scores (SSV; OSS) did not show a significant difference comparing the two manufacturers (p = 0.11, p = 0.85). However, the model evaluating costs identified significant effects related to the type of anchor configuration and manufacturer. Regarding anchor configurations, utilizing anchor configuration 1 or 2 resulted in lower costs by up to CHF 254.51 compared to the reference anchor configuration 4 (p < 0.05), after controlling for age, sex, tear severity, and anchor configuration. Conclusions: The primary findings of this study indicate that although clinical outcomes are generally consistent across various rotator cuff reconstruction scenarios, while secondarily the cost implications can differ significantly and are mainly attributed to the differing numbers of anchors required for each configuration and price setting of the manufacturer. The study underscores the importance of suture construct configuration and manufacturer selection in controlling healthcare costs while maintaining quality patient care. Full article

Objectives: This study aimed to assess the significance of a novel subclassification for partial thickness tears of the subscapularis tendon (SSC) by Yoo and Rhee and to identify key MRI findings predictive of the newly adopted surgical indicator (Yoo type IIB). Methods: Between June 2021 and January 2024, 190 patients undergoing preoperative MRI and arthroscopic rotator cuff repair were enrolled. Patients with arthroscopically confirmed Lafosse type 1 tears (n = 148) who underwent debridement were included. Preoperative MRIs were retrospectively evaluated for SSC tear according to Yoo and Rhee classification, muscle atrophy, fatty infiltration, lesser tuberosity cyst, and long head of the biceps (LHBT) pathologies. Patients were divided into the control (Yoo type I + IIA) and study (Yoo type IIB) groups, and significant associations of MRI findings between the groups were investigated. Results: Among Lafosse type 1 patients, the control group (Yoo type I [n = 70] and Yoo type IIA [n = 41]; n = 111; mean age, 61.8 years ± 9.6, 48 men), and the study group (Yoo type IIB, n = 32; mean age, 66.2 years ± 7.8, 16 men) showed significant differences in age (p = 0.017), but not in gender (p = 0.634). Preoperative MRI findings, including muscle atrophy (p < 0.001), fatty infiltration (p < 0.001), lesser tuberosity cyst (p = 0.033), and LHBT pathologies (full thickness tear, p = 0.040; partial thickness tear, p < 0.001; tendinosis, p = 0.003; subluxation, p < 0.001), differed significantly between the groups. Multivariate analysis identified muscle atrophy (odds ratio [OR] = 33.83, p = 0.008) and LHBT subluxation (OR = 22.83, p < 0.001) as independent predictors for Yoo type IIB. Conclusions: In partial thickness tears of SSC, significant MRI differences were found between the Yoo and Rhee classifications. Notably, muscle atrophy and LHBT subluxation were valuable indicators for predicting Yoo type IIB as a surgical indication. Full article

Musculoskeletal shoulder pain due to rotator cuff (RC) tears is a prevalent condition that significantly impacts function and quality of life. Understanding the underlying pain mechanisms, including movement-evoked pain (MEP) and pain facilitation phenomena such as temporal summation (TS), is essential for improving targeted interventions. This cross-sectional study examined relationships among TS, pain at rest, and MEP in 85 individuals with symptomatic RC tears. Mechanical TS was assessed on the contralateral forearm using standardized mechanical stimuli, while pain at rest and MEP during active arm elevation were measured via numerical rating scales. Spearman’s correlations were performed for the overall cohort and stratified by pain duration (<3 months, acute; ≥3 months, chronic). Weak but statistically significant correlations were found between TS and MEP (r = 0.23, p = 0.02) and between pain at rest and MEP (r = 0.30, p = 0.005), whereas no correlation existed between TS and pain at rest. The logistic regression model showed limited predictive ability. These exploratory findings suggest partially overlapping but distinct pain mechanisms in RC tear patients and should be interpreted as hypothesis-generating, warranting validation in larger, prospective cohorts. Full article

Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Materials and Methods: We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. Results: These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively (p < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. Conclusions: The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications. Full article

Objectives: Metal anchors (MA), commonly used in the early stages of rotator cuff surgical treatment development, are associated with a high risk of complications, especially in osteoporotic bone. As an alternative to rigid anchors, all-suture anchors (ASA) have been introduced for the medial row, offering promising clinical outcomes and favorable biomechanical studies. We aimed to compare the clinical outcomes of MAs and ASAs in either single-row or in medial-row suture bridge techniques in arthroscopic rotator cuff repair. Our hypothesis was that in cases where ASA was used for at least 12 months of follow-up, more favorable results would be obtained as compared to rigid anchors, and intraoperative complications such as anchor pullout would be encountered less. Methods: In this retrospective cohort analysis, we reviewed patients who underwent arthroscopic rotator cuff repair between January 2020 and December 2022. Surgeries were performed by two senior surgeons in a single tertiary center. Patients who had undergone revision surgery, had a history of previous shoulder surgeries, had massive rotator cuff tears, and partial-thickness tears; or had concomitant subscapularis tears were excluded. Preoperative and postoperative scores, including Constant–Murley (CM), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale (VAS), were compared. The minimum follow-up period was 12 months. Clinical assessment of shoulder range of motion included forward flexion, abduction, internal rotation, and external rotation. Intraoperative anchor-related complications were compared. All patients underwent the same surgical technique and postoperative rehabilitation protocol. Results: A total of 142 patients (89 females, 53 males; mean age: 57.4 years) were included in the study, with 67 patients in the ASA group and 75 in the MA group. The sex distribution and mean age were similar between groups. The ASA group had 15 traumatic tears, while the MA group had 13 (p < 0.05). The mean follow-up period was 21.6 months (range 12–40 months). Preoperative CM scores were statistically better in the ASA group, but this difference was not clinically relevant (p < 0.046). The mean CM score was 75.64, the mean DASH score was 8.57, and the mean VAS was 1.38 at the postoperative period in the MA group. The mean CM score was 78.40, the mean DASH score was 9.75, and VAS was 1.59 at the postoperative period in the ASA group. Seven cases experienced anchor pullout in the MA group, and thread breakage occurred in one patient of each group (p = 0.014). The mean age of the patients with anchor pullout was significantly higher (p = 0.002). This finding was not hypothesized in the initial study design but emerged during post-hoc analysis and highlights the importance of considering bone quality in elderly patients. Conclusions: The clinical outcomes of rotator cuff repairs using all-suture anchors or metal anchors are comparable. However, ASA use may offer an advantage in elderly patients by reducing the risk of anchor pullout. Further studies assessing tendon integrity and bone quality and incorporating long-term follow-up periods are recommended to support and validate the present findings. Full article

Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to enhance tendon healing and regeneration. Methods: This case report details the partial repair of a full-thickness rotator cuff tear in a 66-year-old woman, augmented with a bioinductive implant. Postoperative recovery was monitored through clinical examinations, MRI, and kinematic analysis at 3 and 6 months. Results: The findings suggest that bioinductive implants may offer a promising strategy for managing complex rotator cuff tears, particularly when complete repair is not feasible. The patient reported improvement in function and pain reduction. Conclusions: The use of bioinductive implants showed promising results, promoting tendon regeneration and improving functional outcomes. Future research should explore patient selection criteria and the long-term effectiveness of this strategy. Full article

Background: Because of its anatomy and function, the rotator cuff (RC) is vulnerable to considerable morbidity. The prevalence of RC diseases (RCDs) among the general population is 5–39%, reaching over 30% in patients older than 60. The aim of the present systematic review is to investigate the effects of the use of collagen injections in the treatment of RCDs. Methods: A systematic search of scientific electronic databases (such as PubMed, Scopus and Web of Science) was performed up to November 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent authors conducted the search and assessed the articles. The inter-rater reliability for the quality assessment was measured using Cohen’s kappa coefficient, while the Modified Coleman Methodology Score (CMS) was applied to evaluate the methodological quality of the articles included in this systematic review. Results: A total of eight articles were included, with the overall quality of the included articles being evaluated as fair. Despite the use of different types of collagen and injection protocols, as well as the different scores applied, each included study showed clinically relevant improvements. However, given the high degree of heterogeneity of the included studies, we cannot draw conclusions regarding which type of collagen and injection protocol are best for RCD treatment. Discussion: Collagen administration for RCDs seems to be effective at reducing pain and improving function, as well as the tendon structure, especially in partial tears and RC tendinopathy. High-quality, prospective studies with long-term follow-up are necessary to validate the findings of the articles included in this systematic review. Full article

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice. Full article

Background/Objectives: Classical reverse shoulder arthroplasty (RSA) with a high neck–shaft angle (NSA) of 155° has shown satisfactory outcomes. However, newer RSA designs aim to improve results by modifying the stem design. This study evaluates the 5-year outcomes of a stem design featuring a rectangular metadiaphyseal fixation and a 135° NSA. Methods: This prospective bicentric case series included and longitudinally followed up patients that were treated for cuff arthropathy, massive irreparable rotator cuff tears, or eccentric osteoarthritis using a non-cemented rectangular metadiaphyseal fixation stem with a 135° NSA (Univers Revers, Arthrex, Naples, FL, USA). Subjective and objective functional outcome scores (Constant–Murley Score (CS), Shoulder Pain and Disability Index (SPADI), and Subjective Shoulder Value (SSV)), range of motion (ROM), radiographic outcome, adverse events, complications, and quality of life were investigated. Results: This study enrolled 132 patients (59% female, mean age 75 years, SD 6). At the 5-year follow-up, subjective and objective outcomes significantly improved compared to baseline: CS (32.9 to 71.7, p < 0.001), SPADI (38.7 to 86.2, p < 0.001), and SSV (43.0 to 84.1, p < 0.001). ROM improved in flexion (80° to 142.4°, p < 0.001), abduction (71.5° to 130.2°, p < 0.001), internal rotation (p < 0.001), internal rotation at 90° abduction (12.7° to 45.0°, p < 0.001), and abduction strength (0.8 kg to 5.2 kg, p < 0.001). External rotation remained unchanged (32.1° to 32.0°, p = 0.125), but external rotation at 90° abduction improved (20.9° to 52.7°, p < 0.001). No signs of implant migration, subsidence, shift, tilt, alignment loss, or wear were observed, but scapular bone spur formation (11%), scapular notching grade 1 (10%), bone resorption (10%), and partial humeral radiolucent lines (1%) were reported. Conclusions: Rectangular stems with metadiaphyseal fixation and a 135° neck–shaft angle in RSA consistently improve shoulder function, showing no aseptic loosening and minimal radiological changes at 5 years. Full article

Background/Objectives: To evaluate the clinical and radiologic outcomes of arthroscopic augmented partial repair (APR) with acellular dermal matrix versus arthroscopic superior capsular reconstruction (SCR) in massive rotator cuff tears. Methods: The study included a total of 49 patients with massive rotator cuff tears who underwent arthroscopic APR (26 patients) and SCR (23 patients) between March 2018 and June 2021. Clinical scores, visual analog scores, and range of motion were collected preoperatively and postoperatively until the last follow-up. Preoperative and postoperative simple radiographs were evaluated for arthropathic changes and acromiohumeral distances (AHDs). Magnetic resonance imaging was performed to assess the integrity of repaired structures at 12 months postoperatively. Results: The average age of patients was 63.9 years (range 53–74 years), and the mean clinical follow-up period was 2.6 years (range 2.1–2.9). The average UCLA scores improved from 18.0 to 33.2 and from 16.3 to 32.1 in APR and SCR groups at the last follow-up, respectively. For the ranges of motion, the APR group consistently showed better external rotation ranges from the postoperative 6th month until the last follow-up (p < 0.05), and the APR group revealed better ranges of motion in forward flexion, abduction, and external rotation compared to the SCR group (p < 0.05). Postoperative AHD showed better improvement in the APR group than the SCR group (p < 0.05). Re-tears were found in two patients in each group (p > 0.05). Conclusions: Both APR and SCR groups showed comparable improvement in clinical outcomes in massive rotator cuff tears, while the APR group showed statistically significant improvement in the range of motion compared to the SCR group, especially for external rotations. Full article