BOARD CERTIFIED IN ORTHOPAEDIC SURGERY
Advanced Arthroscopic Rotator Cuff Repair
Book an AppointmentEnhancing Healing With REGENETEN® Bioinductive Technology
A New Approach to Rotator Cuff Repair
A rotator cuff tear can affect far more than your shoulder. Pain, weakness, loss of motion, and difficulty sleeping can interfere with work, sports, exercise, and everyday activities.
Modern shoulder surgery has evolved beyond simply repairing a torn tendon. Today, we can combine advanced arthroscopic surgical techniques with biologic augmentation designed to support tendon healing.
For appropriately selected patients, I use the REGENETEN® Bioinductive Implant as part of an advanced approach to rotator cuff repair. This resorbable collagen implant is designed to stimulate new tendon-like tissue formation and reinforce the biological environment of the healing rotator cuff.
The goal is straightforward:
Why Rotator Cuff Repairs Sometimes Fail
Rotator cuff repair involves more than placing sutures in a torn tendon.
The repaired tendon must biologically heal back to bone. Factors such as tear size, tendon quality, age, chronicity of the tear, muscle atrophy, fatty infiltration, and the mechanical demands placed on the shoulder can influence healing.
Even when patients experience substantial improvement in pain and function, structural failure or retear can occur.
Importantly, the 2025 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline for Management of Rotator Cuff Injuries recognizes the importance of tendon healing and gives a strong recommendation for bioinductive tendon implants. The guideline states that these implants used to augment rotator cuff repair—or in selected cases as an alternative to non-augmented repair—can lead to lower retear rates and better patient-reported outcomes.
What Is REGENETEN?
REGENETEN is a bioinductive collagen implant designed specifically for tendon healing.
Rather than functioning simply as a structural patch, the implant is intended to create a biologic environment that encourages the formation of new tendon-like tissue over the treated area.
Over time, the implant is incorporated and resorbed as new tissue develops.
Research has demonstrated increased tendon thickness and evidence of new tissue formation following treatment with the implant. In studies of partial-thickness tears, MRI has demonstrated progressive tissue formation and filling of the original tendon defect.
Advanced Arthroscopic Repair + Biologic Augmentation
When surgery is appropriate, I perform rotator cuff repair using minimally invasive arthroscopic techniques.
Through small portals around the shoulder, the tendon tear is carefully evaluated and repaired using modern fixation techniques. When appropriate based on the patient’s tear characteristics and tissue quality, a REGENETEN implant is placed over the repaired tendon.
This combines two important concepts:
Mechanical Repair
Securely restoring the tendon to its anatomic attachment.
Biologic Augmentation
Creating an environment intended to support new tissue formation and tendon healing.
This combination is particularly appealing when the goal is not simply to repair the tear, but to maximize the likelihood of a durable biological repair.
What Does the Research Show?
The evidence surrounding bioinductive implants has continued to evolve, with prospective studies, randomized trials, and systematic reviews evaluating tendon healing, MRI findings, patient-reported outcomes, and retear rates.
Randomized Clinical Trial Evidence
A randomized, double-blinded clinical trial comparing isolated bioinductive repair with conventional sutured repair for selected small-to-medium full-thickness supraspinatus tears found substantial differences in healing and tendon quality.
At 6 months, MRI demonstrated a greater increase in tendon thickness in the bioinductive group. At 12 and 24 months, all patients in the bioinductive group demonstrated healing on MRI. The bioinductive group also demonstrated higher ASES and Constant-Murley scores, less pain at selected follow-up points, greater satisfaction, and a significantly faster return to work.
These results are particularly relevant because they provide randomized evidence that a bioinductive approach can influence not only the appearance and thickness of the tendon, but also patient-reported outcomes in appropriately selected tears.
Augmentation of Traditional Rotator Cuff Repair
A separate randomized clinical trial involving 124 patients with full-thickness posterosuperior rotator cuff tears evaluated standard arthroscopic repair with and without bioinductive implant augmentation.
The study found a lower retear rate with bioinductive augmentation, while clinical outcomes improved in both groups. Importantly, the clinical outcome differences between groups were not necessarily large despite the difference in structural healing.
This distinction is important: improved structural healing does not always translate into dramatically different pain or functional scores, because many factors contribute to how a patient feels and functions after surgery.
Partial-Thickness Rotator Cuff Tears
Prospective multicenter research has also evaluated the use of the implant for selected partial-thickness tears.
At two years, patients demonstrated significant improvements in ASES and Constant-Murley scores. MRI demonstrated new tissue filling of the original tear in 100% of intermediate-grade tears and 95% of high-grade tears in that study, with measurable increases in tendon thickness.
What Do Systematic Reviews Show?
A 2024 systematic review examining 17 studies and more than 1,000 rotator cuff tears reported sustained improvements in ASES and Constant-Murley scores and increases in tendon thickness on MRI. However, the authors also emphasized that additional randomized controlled trials are needed and that clinical outcomes may remain within the range seen with conventional rotator cuff repair.
In other words, the current evidence is encouraging—particularly regarding structural tendon healing and retear rates—but REGENETEN should not be presented as a guaranteed improvement for every patient.
What Does AAOS Recommend?
The 2025 AAOS Clinical Practice Guideline for Management of Rotator Cuff Injuries specifically addresses bioinductive implants.
AAOS gives the use of bioinductive tendon implants a:
Strong Recommendation
High Quality of Evidence
The guideline concludes that bioinductive tendon implants used to augment rotator cuff repair, or in selected circumstances as an alternative to non-augmented repair, can lead to lower retear rates and better patient-reported outcomes.
This represents an important development in the management of rotator cuff disease.
AAOS also notes that the technology has potential drawbacks, including increased operative time and additional cost, and identifies the need for further high-quality research to better define which patients benefit most.
Who May Benefit From REGENETEN?
REGENETEN is not necessary for every rotator cuff tear.
I consider biologic augmentation based on the individual patient’s anatomy, tear pattern, tendon quality, activity level, age, expectations, and risk factors for failed healing.
Potential candidates may include appropriately selected patients with:
- Partial-thickness rotator cuff tears
- Small- to medium-sized full-thickness tears
- Poor-quality or degenerative tendon tissue
- Tears where maximizing biological healing is a particular concern
- Selected larger or higher-risk tears
- Certain revision rotator cuff repairs
For large and massive tears, the evidence is more variable. Studies have demonstrated improvements in pain and function, but predictable healing remains challenging in some patients with extensive or retracted disease.
The decision to use a bioinductive implant is therefore individualized rather than automatic.
The Advantage of an Arthroscopic Approach
Arthroscopic shoulder surgery allows the surgeon to evaluate the entire joint and rotator cuff through small incisions.
Depending on the patient’s pathology, treatment may include:
- Arthroscopic rotator cuff repair
- REGENETEN bioinductive augmentation
- Treatment of associated biceps pathology
- Labral treatment when indicated
- Management of cartilage disease
- Removal of inflamed or damaged tissue
- Other procedures tailored to the individual shoulder
The objective is to address the entire pathology, rather than simply treating the visible tendon tear.
The 2025 AAOS guideline notes that arthroscopic repair provides similar long-term patient-reported outcomes and healing compared with open repair, while arthroscopic-only techniques are associated with better short-term recovery of motion and lower pain scores.
Healing Is the Goal—Not Just Repair
The ultimate objective of rotator cuff surgery is not simply to make the tendon look repaired in the operating room.
It is to help the tendon heal to bone, restore shoulder function, reduce pain, and allow the patient to return to the activities that matter most.
REGENETEN represents an evolution in this philosophy by adding a biologic component to mechanical tendon repair.
Repair the tendon.
Support the biology.
Protect the healing process.
Restore function.
A Personalized Approach to Shoulder Surgery
Every rotator cuff tear is different.
Before recommending surgery, I evaluate the patient’s symptoms, physical examination, imaging studies, tear size and pattern, tendon quality, muscle atrophy, fatty infiltration, activity level, and goals.
For some patients, physical therapy and nonoperative treatment may be appropriate.
For others, arthroscopic repair is the best option.
And for appropriately selected patients undergoing repair, REGENETEN bioinductive augmentation may provide an additional tool to optimize the healing environment. My goal is to use the most advanced techniques when they are supported by evidence—and to recommend them only when they make sense for the individual patient.
If You Have a Rotator Cuff Tear
If shoulder pain, weakness, or loss of function is interfering with your work, sports, sleep, or daily life, a comprehensive shoulder evaluation can determine the source of the problem and identify your treatment options.
Advanced diagnosis. Precise arthroscopic repair. Biologic healing technology.
Schedule a shoulder consultation to learn whether arthroscopic rotator cuff repair with REGENETEN may be appropriate for you.
REGENETEN is not appropriate for every rotator cuff tear, and individual results vary. The decision to use a bioinductive implant is based on the patient’s diagnosis, anatomy, tissue quality, medical history, and treatment goals. No surgical procedure can guarantee tendon healing or a specific functional outcome.
