Rotator cuff pathology is a significant cause of shoulder pain. Operative
repair of rotator cuff is an established standard of care for these patient,
however, failure of the procedure is common. Systemic conditions such as
diabetes mellitus, hypocholesteremia, thyroid disease, and smoking significantly
affect the outcomes of rotator cuff repair and have significant implications for
the management of these patients. Diabetes mellitus has been proposed to damage
tendons through non-enzymatic glycosylation of collagen with advanced glycation
end product formation and impaired microcirculation. Hypocholesteremia may lead
to fatty infiltration and subsequent pro-inflammatory degenerative enzymatic
degeneration. Thyroid disease may disrupt tendon homeostasis through the
alteration of collagen production and the accumulation of glycosaminoglycans.
Lastly, smoking inhibits tendon healing through the induction of hypovascularity
and hypoperfusion. Understanding of the implications these systemic conditions
have on the outcomes is important in the management of rotator cuff disease.