Summary of Recommendations and Options

Document Overview

Design and created by Guideline Central in participation with the American Academy of Orthopaedic Surgeons.

Management of Rotator Cuff Injuries

American Academy of Orthopaedic Surgeons

Publication Date: Aug 18, 2025

Page Last Updated: Jul 28, 2026

Quality of Evidence and Strength of Statements

Statement Strength	Quality Evidence	Statement Description
Strong	High*	Evidence from two or more “High” quality studies with consistent findings recommending for or against the intervention. Or Rec is upgraded using the EtD framework.
Moderate	Moderate*	Evidence from two or more “Moderate” quality studies with consistent findings or evidence from a single “High” quality study recommending for or against the intervention. Or Rec is upgraded or downgraded using the EtD framework.
Limited	Low*	Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for or against the intervention. Or Rec is downgraded using the EtD framework.
Consensus*	Very low or consensus*	Evidence from one “Low” quality study, no supporting evidence, or Rec is downgraded using the EtD framework. In the absence of sufficient evidence, the guideline workgroup is making a statement based on their clinical opinion.

*Unless statement was upgraded or downgraded in strength, using the EtD Framework.

Document Overview

Document Title: Management of Rotator Cuff Injuries

Authoring Society: American Academy of Orthopaedic Surgeons

Document Publication Date: Aug 18, 2025

Page Last Reviewed/Updated: Jul 28, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.aaos.org/globalassets/quality-and-practice-resources/rotator-cuff/rotator-cuff-2025/rotator-cuff-cpg.pdf

Source Citation: American Academy of Orthopaedic Surgeons Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline. aaos.org/rccpg2025 Published 08/18/2025

Supplemental Implementation Resources

Quick-Reference Guide

Document Scope, Criteria, and Use Cases

Document Objectives: This clinical practice guideline is based on a systematic review of published studies with regard to the management of rotator cuff injuries. In addition to providing practice recommendations, this guideline also highlights limitations in the literature and areas that require future research. This guideline is intended to be used by all qualified and appropriately trained physicians and surgeons involved in the management of rotator cuff injuries. It is also intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations.

Scope: Management, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D017006 - Rotator Cuff

D000070636 - Rotator Cuff Injuries

D000070656 - Rotator Cuff Tear Arthropathy

Keywords: rotator cuff injury, rotator cuff tear

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Methodology

Number of Source Documents: 591

Literature Search Start Date: Sunday, October 1, 2023

Literature Search End Date: Friday, June 7, 2024

Includes peer/external review process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Strength of Statement	Patient Counseling (Time)	Decision Aids	Impact of Future Research
Strong	Least	Least Important, unless the evidence supports no difference between two alternative interventions	Not likely to change
Moderate	Less	Less important	Less likely to change
Limited	More	Important	Changepossible/anticipated
Consensus	Most	Most important	Impact unknown

Management of Rotator Cuff Injuries

Summary of Recommendations and Options

MANAGEMENT OF SMALL TO MEDIUM TEARS

LONG TERM NON-OPERATIVE MANAGEMENT

OPERATIVE MANAGEMENT VS NON-OPERATIVE MANAGEMENT

ACROMIOPLASTY & ROTATOR CUFF REPAIR

DIAGNOSIS (CLINICAL EXAMINATION)

DIAGNOSIS (IMAGING)

POST-OP MOBILIZATION TIMING

POST-OP SLING USE

SUPERVISED EXERCISE VS UNSUPERVISED EXERCISE

CORTICOSTEROID INJECTIONS FOR ROTATOR CUFF TEARS

PROLOTHERAPY

HIGH-GRADE PARTIAL-THICKNESS ROTATOR CUFF TEARS

PARTIAL ROTATOR CUFF TEAR

BIOLOGICAL AUGMENTATION WITH PLATELET DERIVED PRODUCTS

SINGLE-ROW VS DOUBLE ROW REPAIR – PATIENT REPORTED OUTCOMES

SINGLE-ROW VS DOUBLE ROW REPAIR - RETEARS

MARROW STIMULATION

DERMAL ALLOGRAFTS

BIOINDUCTIVE IMPLANTS

OPEN VS ARTHROSCOPIC REPAIRS

POSTOPERATIVE PAIN MANAGEMENT

HYALURONIC ACID INJECTIONS FOR ROTATOR CUFF PATHOLOGY

PLATELET RICH PLASMA (PRP) INJECTION IN PARTIAL-THICKNESS TEARS

MULTIPLE STEROID INJECTIONS FOR ROTATOR CUFF TEARS

PLATELET RICH PLASMA (PRP) INJECTION IN FULL-THICKNESS TEARS

UNREPAIRABLE TEARS WITHOUT ARTHROPATHY (NON-REVERSE ARTHROPLASTY)

MASSIVE UNREPAIRABLE ROTATOR CUFF TEAR WITHOUT ARTHROPATHY (REVERSE ARTHROPLASTY)

MASSIVE UNREPAIRABLE TEARS WITH ARTHROPATHY (REVERSE ARTHROPLASTY)

SURGICAL TREATMENT VS. PHYSICAL THERAPY FOR LOW- OR INTERMEDIATE-GRADE PARTIAL-THICKNESS TEARS

Quality of Evidence and Strength of Statements

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology