Review ArticlesBiological Factors in the Pathogenesis of Rotator Cuff TearsMaffulli, Nicola MD, MS, PhD, FRCS(Orth)*; Longo, Umile Giuseppe MD, MSc†,‡; Berton, Alessandra MD†; Loppini, Mattia MD†; Denaro, Vincenzo MD†Author Information *Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, Mile End Hospital ‡Department of Orthopaedics, Royal Free Hampstead NHS Trust, London, UK †Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria Rome, Italy The authors declare no conflict of interest. Reprints: Nicola Maffulli, MD, MS, PhD, FRCS(Orth), Centre Lead and Professor of Sports and Exercise Medicine, Consultant Trauma and Orthopaedic Surgeon, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England (e-mail email@example.com). Sports Medicine and Arthroscopy Review: September 2011 - Volume 19 - Issue 3 - p 194-201 doi: 10.1097/JSA.0b013e3182250cad Buy Metrics Abstract Rotator cuff tears are common, and lead to shoulder pain and functional impairment. Despite their frequency and related disability, etiology and pathogenesis are still debated. Multiple factors contribute to tears of the rotator cuff. Extrinsic factors are anatomic variables, such as acromial morphologic characteristics, os acromiale, and acromial spurs that compress the rotator cuff by bony impingement or direct pressure from the surrounding soft tissue. Intrinsic factors arise from the tendon itself, because of tensile overload, aging, microvascular supply, traumatisms, or degeneration. Little information is available from a cellular and molecular point of view. We reviewed the biological factors involved in the pathogenesis of rotator cuff tears. Understanding the mechanism of rotator cuff pathology would facilitate the rationale for therapeutic interventions, by guiding the design, selection, and implementation of treatment strategies such as biologic modulation and preventive measures. © 2011 Lippincott Williams & Wilkins, Inc.