Interpretation of the 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Ye Yi , Lu Bing , Li Jia Hong ,  Zhang Kun

Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu Sichuan, 610072, P. R. China;

Corresponding?author：

Zhang Kun, Email: 18880442561@163.com

Keywords：

Rotator cuff injury; clinical practice guideline; American Academy of Orthopaedic Surgeons; guideline interpretation

DOI：

10.7507/1002-1892.202511084

Video：

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The American Academy of Orthopaedic Surgeons (AAOS) released the updated Evidence-Based Clinical Practice Guideline for the Management of Rotator Cuff Injuries in August 2025. The guideline provides 25 recommendations and 4 consensus statements across diagnosis, treatment decision-making, biologic interventions, and postoperative rehabilitation, with the strength of each recommendation graded according to the quality of supporting evidence. The updated guideline highlights several key advances, including establishing CT as an important adjunctive imaging modality, providing specific recommendations on repair strategies for high-grade partial-thickness rotator cuff tears, and clearly restricting the use of platelet-rich plasma and marrow stimulation in rotator cuff repair, as well as limiting the application of prolotherapy in the treatment of full-thickness rotator cuff tears. In addition, the guideline emphasizes the potential benefits of early mobilization in patients with small to medium-sized tears.

1.	Bedi A, Bishop J, Keener J, et al. Rotator cuff tears. Nat Rev Dis Primers, 2024, 10(1): 8. doi: 10.1038/s41572-024-00492-3.
2.	Yanik E, Colditz G, Wright R, et al. Risk factors for surgery due to rotator cuff disease in a population-based cohort. Bone joint J, 2020, 102B(3): 352-359.
3.	張凱搏, 唐新, 李箭, 等. 2019年美國骨科醫師學會(AAOS)肩袖損傷臨床實踐指南解讀. 中國運動醫學雜志, 2020, 39(5): 403-412.
4.	American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Clinical Practice Guideline[EB/OL]. (2025-08-28) [2025-11-18]. https://www.aaos.org/quality/quality-programs/rotator-cuff/.
5.	Jeong JY, Kim SC, Lee SM, et al. Prospective randomized clinical trial of arthroscopic repair versus debridement for partial subscapularis tendon tears more than half of the entire first facet. Am J Sports Med, 2023, 51(11): 2804-2814.
6.	Ranebo MC, Hallgren H, Holmgren T, et al. Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: A prospective randomized trial. J Shoulder Elbow Surg, 2020, 29(3): 459-470.
7.	Cederqvist S, Flinkkil? T, Sormaala M, et al. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis, 2021, 80(6): 796-802.
8.	Moosmayer S, Lund G, Seljom US, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg (Am), 2019, 101(12): 1050-1060.
9.	Ono Y, LeBlanc J, Bois A J, et al. Graft healing is more important than graft technique: Superior capsular reconstruction versus bridging grafts-a prospective randomized controlled trial. Arthroscopy, 2022, 38(12): 3109-3117.
10.	Wong I, Sparavalo S, King JP, et al. Bridging allograft reconstruction is superior to maximal repair for the treatment of chronic, massive rotator cuff tears: Results of a prospective, randomized controlled trial. Am J Sports Med, 2021, 49(12): 3173-3183.
11.	Baek CH, Kim JG, Baek GR. Restoration of active internal rotation following reverse shoulder arthroplasty: Anterior latissimus dorsi and teres major combined transfer. J Shoulder Elbow Surg, 2022, 31(6): 1154-1165.
12.	Ameziane Y, Holschen M, Engel N M, et al. Does the subscapularis repair affect the clinical outcome after primary reverse shoulder arthroplasty? J Shoulder Elbow Surg, 2024, 33(9): 1909-1917.
13.	Heuberer PR, Pauzenberger L, Gruber MS, et al. Delaminated rotator cuff tears showed lower short-term retear rates after arthroscopic double-layer repair versus bursal layer-only repair: A randomized controlled trial. Am J Sports Med, 2020, 48(3): 689-696.
14.	Lapner P, Li A, Pollock JW, et al. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair: Long-term follow-up. Am J Sports Med, 2021, 49(11): 3021-3029.
15.	Carbonel I, Martinez AA, Calvo A, et al. Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: A prospective randomized clinical study. Int Orthop, 2012, 36(9): 1877-1883.
16.	Randelli PS, Stoppani CA, Santarsiero G, et al. Platelet-rich plasma in arthroscopic rotator cuff repair: Clinical and radiological results of a prospective randomized controlled trial study at 10-year follow-up. Arthroscopy, 2022, 38(1): 51-61.
17.	Rossi LA, Gorodischer TD, Camino P, et al. Leukocyte-poor platelet-rich plasma as an adjuvant to arthroscopic rotator cuff repair reduces the retear rate but does not improve functional outcomes: a double-blind randomized controlled trial. Am J Sports Med, 2024, 52(6): 1403-1410.
18.	Zhang C, Cai Y Z, Wang Y. Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears does not improve clinical outcomes but reduces retear rates and fatty infiltration: A prospective, single-blinded randomized study. Arthroscopy, 2022, 38(8): 2381-2388. e1.
19.	Hsieh LF, Lin YJ, Hsu WC, et al. Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial. Clin Rehabil, 2021, 35(9): 1305-1316.
20.	Cai YU, Sun Z, Liao B, et al. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Med Sci Sports Exerc, 2019, 51(2): 227-233.
21.	Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, et al. Periarticular neurofascial dextrose prolotherapy versus physiotherapy for the treatment of chronic rotator cuff tendinopathy: Randomized clinical trial. J Clin Rheumatol, 2021, 27(4): 136-142.
22.	Chang YJ, Chang FH, Hou PH, et al. Effects of hyperosmolar dextrose injection in patients with rotator cuff disease and bursitis: A randomized controlled trial. Arch Phys Med Rehabil, 2021, 102(2): 245-250.
23.	Lee GW, Kim JY, Lee HW, et al. Clinical and anatomical outcomes of arthroscopic repair of large rotator cuff tears with allograft patch augmentation: A prospective, single-blinded, randomized controlled trial with a long-term follow-up. Clin Orthop Surg, 2022, 14(2): 263-271.
24.	Snow M, Kuiper JH, James S, et al. A pilot randomised controlled trial assessing standard versus dermal patch-augmented rotator cuff repair found no adverse effects and suggest future trials need a minimum of 150 patients. Knee Surg Sports Traumatol Arthrosc, 2023, 31(7): 2654-2661.
25.	Ruiz Ibán M, García Navlet M, Moros Marco S, et al. Augmentation of a transosseous-equivalent repair in posterosuperior nonacute rotator cuff tears with a bioinductive collagen implant decreases the retear rate at 1 year: A randomized controlled trial. Arthroscopy, 2024, 40(6): 1760-1773.
26.	Camacho Chacón JA, Roda Rojo V, Martin Martinez A, et al. An isolated bioinductive repair vs sutured repair for full-thickness rotator cuff tears: 2-year results of a double blinded, randomized controlled trial. J Shoulder Elbow Surg, 2024, 33(9): 1894-1904.
27.	Milano G, Saccomanno M F, Careri S, et al. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: A prospective randomized study. Arthroscopy, 2013, 29(5): 802-810.
28.	Sheps DM, Silveira A, Beaupre L, et al. Early active motion versus sling immobilization after arthroscopic rotator cuff repair: A randomized controlled trial. Arthroscopy, 2019, 35(3): 749-760. e742.
29.	Tirefort J, Schwitzguebel AJ, Collin P, et al. Postoperative mobilization after superior rotator cuff repair: Sling versus no sling: A randomized prospective study. J Bone Joint Surg (Am), 2019, 101(6): 494-503.
30.	Littlewood C, Bateman M, Butler-Walley S, et al. Rehabilitation following rotator cuff repair: A multi-centre pilot & feasibility randomised controlled trial (racer). Clin Rehabil, 2021, 35(6): 829-839.
31.	Karppi P, Ry?s? A, Kukkonen J, et al. Effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction: A randomized controlled trial. J Shoulder Elbow Surg, 2020, 29(9): 1765-1774.
32.	Jildeh TR, Abbas MJ, Hasan L, et al. Multimodal nonopioid pain protocol provides better or equivalent pain control compared to opioid analgesia following arthroscopic rotator cuff surgery: A prospective randomized controlled trial. Arthroscopy, 2022, 38(4): 1077-1085.

1. Bedi A, Bishop J, Keener J, et al. Rotator cuff tears. Nat Rev Dis Primers, 2024, 10(1): 8. doi: 10.1038/s41572-024-00492-3.
2. Yanik E, Colditz G, Wright R, et al. Risk factors for surgery due to rotator cuff disease in a population-based cohort. Bone joint J, 2020, 102B(3): 352-359.
3. 張凱搏, 唐新, 李箭, 等. 2019年美國骨科醫師學會(AAOS)肩袖損傷臨床實踐指南解讀. 中國運動醫學雜志, 2020, 39(5): 403-412.
4. American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Clinical Practice Guideline[EB/OL]. (2025-08-28) [2025-11-18]. https://www.aaos.org/quality/quality-programs/rotator-cuff/.
5. Jeong JY, Kim SC, Lee SM, et al. Prospective randomized clinical trial of arthroscopic repair versus debridement for partial subscapularis tendon tears more than half of the entire first facet. Am J Sports Med, 2023, 51(11): 2804-2814.
6. Ranebo MC, Hallgren H, Holmgren T, et al. Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: A prospective randomized trial. J Shoulder Elbow Surg, 2020, 29(3): 459-470.
7. Cederqvist S, Flinkkil? T, Sormaala M, et al. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis, 2021, 80(6): 796-802.
8. Moosmayer S, Lund G, Seljom US, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg (Am), 2019, 101(12): 1050-1060.
9. Ono Y, LeBlanc J, Bois A J, et al. Graft healing is more important than graft technique: Superior capsular reconstruction versus bridging grafts-a prospective randomized controlled trial. Arthroscopy, 2022, 38(12): 3109-3117.
10. Wong I, Sparavalo S, King JP, et al. Bridging allograft reconstruction is superior to maximal repair for the treatment of chronic, massive rotator cuff tears: Results of a prospective, randomized controlled trial. Am J Sports Med, 2021, 49(12): 3173-3183.
11. Baek CH, Kim JG, Baek GR. Restoration of active internal rotation following reverse shoulder arthroplasty: Anterior latissimus dorsi and teres major combined transfer. J Shoulder Elbow Surg, 2022, 31(6): 1154-1165.
12. Ameziane Y, Holschen M, Engel N M, et al. Does the subscapularis repair affect the clinical outcome after primary reverse shoulder arthroplasty? J Shoulder Elbow Surg, 2024, 33(9): 1909-1917.
13. Heuberer PR, Pauzenberger L, Gruber MS, et al. Delaminated rotator cuff tears showed lower short-term retear rates after arthroscopic double-layer repair versus bursal layer-only repair: A randomized controlled trial. Am J Sports Med, 2020, 48(3): 689-696.
14. Lapner P, Li A, Pollock JW, et al. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair: Long-term follow-up. Am J Sports Med, 2021, 49(11): 3021-3029.
15. Carbonel I, Martinez AA, Calvo A, et al. Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: A prospective randomized clinical study. Int Orthop, 2012, 36(9): 1877-1883.
16. Randelli PS, Stoppani CA, Santarsiero G, et al. Platelet-rich plasma in arthroscopic rotator cuff repair: Clinical and radiological results of a prospective randomized controlled trial study at 10-year follow-up. Arthroscopy, 2022, 38(1): 51-61.
17. Rossi LA, Gorodischer TD, Camino P, et al. Leukocyte-poor platelet-rich plasma as an adjuvant to arthroscopic rotator cuff repair reduces the retear rate but does not improve functional outcomes: a double-blind randomized controlled trial. Am J Sports Med, 2024, 52(6): 1403-1410.
18. Zhang C, Cai Y Z, Wang Y. Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears does not improve clinical outcomes but reduces retear rates and fatty infiltration: A prospective, single-blinded randomized study. Arthroscopy, 2022, 38(8): 2381-2388. e1.
19. Hsieh LF, Lin YJ, Hsu WC, et al. Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial. Clin Rehabil, 2021, 35(9): 1305-1316.
20. Cai YU, Sun Z, Liao B, et al. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Med Sci Sports Exerc, 2019, 51(2): 227-233.
21. Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, et al. Periarticular neurofascial dextrose prolotherapy versus physiotherapy for the treatment of chronic rotator cuff tendinopathy: Randomized clinical trial. J Clin Rheumatol, 2021, 27(4): 136-142.
22. Chang YJ, Chang FH, Hou PH, et al. Effects of hyperosmolar dextrose injection in patients with rotator cuff disease and bursitis: A randomized controlled trial. Arch Phys Med Rehabil, 2021, 102(2): 245-250.
23. Lee GW, Kim JY, Lee HW, et al. Clinical and anatomical outcomes of arthroscopic repair of large rotator cuff tears with allograft patch augmentation: A prospective, single-blinded, randomized controlled trial with a long-term follow-up. Clin Orthop Surg, 2022, 14(2): 263-271.
24. Snow M, Kuiper JH, James S, et al. A pilot randomised controlled trial assessing standard versus dermal patch-augmented rotator cuff repair found no adverse effects and suggest future trials need a minimum of 150 patients. Knee Surg Sports Traumatol Arthrosc, 2023, 31(7): 2654-2661.
25. Ruiz Ibán M, García Navlet M, Moros Marco S, et al. Augmentation of a transosseous-equivalent repair in posterosuperior nonacute rotator cuff tears with a bioinductive collagen implant decreases the retear rate at 1 year: A randomized controlled trial. Arthroscopy, 2024, 40(6): 1760-1773.
26. Camacho Chacón JA, Roda Rojo V, Martin Martinez A, et al. An isolated bioinductive repair vs sutured repair for full-thickness rotator cuff tears: 2-year results of a double blinded, randomized controlled trial. J Shoulder Elbow Surg, 2024, 33(9): 1894-1904.
27. Milano G, Saccomanno M F, Careri S, et al. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: A prospective randomized study. Arthroscopy, 2013, 29(5): 802-810.
28. Sheps DM, Silveira A, Beaupre L, et al. Early active motion versus sling immobilization after arthroscopic rotator cuff repair: A randomized controlled trial. Arthroscopy, 2019, 35(3): 749-760. e742.
29. Tirefort J, Schwitzguebel AJ, Collin P, et al. Postoperative mobilization after superior rotator cuff repair: Sling versus no sling: A randomized prospective study. J Bone Joint Surg (Am), 2019, 101(6): 494-503.
30. Littlewood C, Bateman M, Butler-Walley S, et al. Rehabilitation following rotator cuff repair: A multi-centre pilot & feasibility randomised controlled trial (racer). Clin Rehabil, 2021, 35(6): 829-839.
31. Karppi P, Ry?s? A, Kukkonen J, et al. Effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction: A randomized controlled trial. J Shoulder Elbow Surg, 2020, 29(9): 1765-1774.
32. Jildeh TR, Abbas MJ, Hasan L, et al. Multimodal nonopioid pain protocol provides better or equivalent pain control compared to opioid analgesia following arthroscopic rotator cuff surgery: A prospective randomized controlled trial. Arthroscopy, 2022, 38(4): 1077-1085.

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Latest ArticlesInterpretation of the 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline

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