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Enthesis augmentation in rotator cuff repair

Welcome to Question for Physiotherapists May 2026. This month Dr Doron Sher discusses enthesis augmentation in rotator cuff repair.

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QUESTION | What is Enthesis augmentation in rotator cuff repair?

ANSWER |

Despite major advances in technology the retear rate of the rotator cuff following repair is higher than we would like it to be. Until now the focus has been on reinforcing or thickening the tendon with various types of patches but recently the emphasis has changed to biological enhancement instead. This is designed to recreate the original tendon-bone interface of Sharpey’s fibres rather than healing with weak scar tissue.

The rotator cuff attaches to bone in four layers as seen below. Unfortunately tendon does not heal very well to bone in a natural enthesis. Instead you end up with Fibrovascular scar formation which is more likely to fail in the future.

One of the solutions to the problem which is under clinical review at the moment is to augment the enthesis with an allograft bone plug. This provides osteogenesis, osteinduction and osteoconduction to the area to promote healing with Sharpey’s fibres and formation of normal tendon.

The product can be used to augment the bone and place the anchor into it to provide better fixation, or can be used between anchors to provide a biological enhancement of the repair.

The animal studies show that it improves both short and long term fixation outcomes and the early human clinical trials are showing a lower retear rate compared to patients that have not had the implant used.

The type of fixation used does not seem to matter very much when it comes to healing of the tendon and both single and double row repairs show good clinical outcomes. The goal is to reduce micromotion at the repair site during healing because excessive strain can disrupt fibrocartilage formation. This generally means doing absolutely no physiotherapy exercises in the first 6 weeks post surgery.

The images below show an example of the healing of the rotator cuff with use of the Tetrous product but even a biologically enhanced repair can fail if:

loading progresses too aggressively
scapular mechanics are poor
stiffness develops
strength deficits persist

So surgery and rehab remain tightly linked.

While it is still early in the clinical trial the results have been extremely encouraging. There are virtually no contra-indications to using the product and if the ongoing results are as good as the early results this will become a routine part of every rotator cuff operation moving forward.

Dr Doron Sher

Dec-2020	Wrist Ganglions	Dr Kwan Yeoh
Oct/Nov-2020	Medial Meniscal Root Tears	Dr Doron Sher
Sep-2020	Lumbar Stress Fractures	Dr Paul Annett
Aug-2020	Frailty and Healthy Ageing	Dr John Best
Jul-2020	Thumb – Collateral Ligament Tear	Dr Kwan Yeoh
Jun-2020	Shoulder Instability	Dr Doron Sher
May-2020	Hallux Rigidus	Dr John Negrine
Mar/Apr-2020	Achilles Tendon Ruptures	Dr Todd Gothelf
Feb-2020	Distal Biceps	Dr Doron Sher
Nov-2019	Clavicle Fracture Internal Fixation	Dr Doron Sher
Oct-2019	Femoracetabular Impingement (FAI)	Dr Paul Mason
Sep-2019	Imaging for Acute ACL Injuries	Dr Doron Sher
Aug-2019	Joint Relocation	Dr Paul Annett
Jul-2019	Guyon canal surgery	Dr Kwan Yeoh
Jun-2019	Whats new in ACL reconstruction 2019	Dr Doron Sher
May-2019	Cuneiform Fracture	Dr Todd Gothelf
Apr-2019	Flexor Tendon Injuries	Dr Kwan Yeoh
Mar-2019	Chronic Exertional Compartment Synd	Dr Paul Annett
Feb-2019	Achilles Tendon Rupture	Dr John Negrine
Nov-2018	Low Back Pain	Dr Paul Mason
Sep-2018	Concussion part 2	Dr John Best
Jul-2018	Concussion part1	Dr Paul Annett
Jun-2018	Thessaly & McMurray Test	Dr Doron Sher
May-2018	AC Joint	Dr Doron Sher
Apr-2018	Arthritis of the fingers	Dr Kwan Yeoh
Feb-2018	CLAVICLE fractures	Dr Doron Sher
Oct-2017	ACL Grafts	Dr Doron Sher
Sep-2017	Forefoot pain	Dr John Negrine
Aug-2017	Wrist Ganglion	Dr Kwan Yeoh
Jul-2017	Anterolateral Ligament Reconstruction	Dr Doron Sher
Jun-2017	Scapholunate ligament	Dr Kwan Yeoh
Apr-2017	Knee Brace – ACL Reconstruction	Dr Doron Sher
Mar-2017	Sesamoid fractures	Dr Kwan Yeoh
Feb-2017	Plantar Fasciitis	Dr Todd Gothelf
Nov-2016	Sternoclavicular Joint	Dr Doron Sher
Oct-2016	Proximal Humerus Fractures	Dr David Lieu
Sep-2016	Wrist Fractures	Dr Kwan Yeoh
Aug-2016	Patella Instability	Dr Doron Sher
Jul-2016	Snowboarders ankle	Dr Todd Gothelf
May-2016	Cortisone Injections	Dr Paul Annett
Apr-2016	Shoulder Instability_1	Dr Ivan Popoff
Mar-2016	Exercise after TKR	Dr Doron Sher
Dec-2015	Scaphoid OA	Dr Kwan Yeoh
Nov-2015	Greater Tuberosity Fractures	Dr Doron Sher
Oct-2015	Stress Fractures	Dr Paul Annett
Sep-2015	Boxers Fractures	Dr Kwan Yeoh
Aug 2015	Resistance Training	Dr John Best
July 2015	LARS Ligament	Dr Ivan Popoff
Jun-2015	Distal Biceps	Dr Doron Sher
May-2015	Latarjet procedure	Dr Jerome Goldberg
Apr-2015	TFCC Questions	Dr Kwan Yeoh
Mar-2015	Acute Ankle Sprains	Dr Todd Gothelf
Nov-2014	PRPP	Dr Paul Annett
Oct-2014	Driving After Surgery	Dr Doron Sher
Sep-2014	Distal Biceps Rupture	Dr Doron Sher
Aug-2014	Ankle Sprain	Dr Todd Gothelf
Jun-2014	Patella Dislocation	Dr Doron Sher
May-2014	Shoulder Instability	Dr Todd Gothelf
Apr-2014	De Quervains	Dr Kwan Yeoh
Mar-2014	Acromio-clavicular joint injuries	Dr Todd Gothelf
Feb-2014	Chronic Knee Pain	Dr Paul Annett
Dec-2013	Foot and Ankle Questions	Dr John Negrine
Oct-2013	Rotator Cuff Repair	Dr Todd Gothelf
Sep-2013	ACL Reconstruction	Dr Doron Sher
Jul-2013	Slipped Upper femoral epiphysis	Dr Rod Pattinson
May-2013	Skiers thumb	Dr Kwan Yeoh
Apr-2013	Bakers_Cyst	Dr Ivan Popoff
Mar-2013	Tibial Osteotomy vs UKR	Dr Doron Sher
Feb-2013	ALIF success rate	Dr Andreas Loefler
Jan-2013	Lisfranc Injuries	Dr Todd Gothelf
Nov-2012	Anterior Spinal Fusions	Dr Andreas Loefler
Oct-2012	MCL Injuries	Dr Doron Sher
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Apr-2012	Syndesmosis Sprain	Dr Todd Gothelf
Mar-2012	Triangular Fiocartilage Injuries	Dr Kwan Yeoh
Jan-2012	Shoulder Replacement Older Population	Dr Jerome Goldberg
Dec-2011	Wrist Fracture	Dr Kwan Yeoh
Nov-2011	Adductor Tendon Tear	Dr Paul Annett
Oct-2011	Navicular Pain	Dr Todd Gothelf
Sep-2011	OCD Lesion	Dr Doron Sher
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July-2011	Femoral Neck Stress Fract (Pt 2)	Dr John Best
Jun-2011	Femoral Neck Stress Fractures	Dr John Best
May-2011	PCL Injury Part 2	Dr Doron Sher
Apr-2011	PCL Injury Part 1	Dr DoronSher
Mar-2011	Prolotherapy Autologous Blood Injections	DrPaul Annett
Feb-2011	Shoulder Impingement	Dr Todd Gothelf
Dec-2010	Does Chondral Grafting Work	DrDoron Sher
Nov-2010	Shoulder Immobilisation-Dislocation	Dr Jerome Goldberg
Sep-2010	SLAP Lesions Stable Shoulder	Dr ToddGothelf
Jul-2010	Ankle Sprains	Dr Todd Gothelf
Jun-2010	Dislocation After THR	Dr Peter Walker
May-2010	Acupuncture Muscle Strength Programmes	Dr Paul Annett
April-2010	Full Thickness Rotator Cuff Tears	Dr JeromeGoldberg
Mar-2010	Skiing after TKR	Prof Warwick Bruce
Feb-2010	Fractures of the Clavicle	Dr John Trantalis
Jan-2010	Osteoarthritis of the Knee	Dr Doron Sher
Dec-2009	Fifrth Metatarsal Fractures	Dr Todd Gothelf
Nov-2009	Partial Rotator Cuff Tears	Dr Todd Gothelf

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Question for Physiotherapists

Enthesis augmentation in rotator cuff repair

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