Synovectomy During Rotator Cuff Repair — No Additional Benefit at Three Months

Polish version: Synowektomia przy naprawie stożka rotatorów — brak dodatkowej korzyści po 3 miesiącach

Should inflamed synovium routinely be removed during arthroscopic rotator cuff repair? A randomised trial published on 20 August 2026 in Orthopaedic Journal of Sports Medicine found no improvement in early postoperative outcomes from adding synovectomy.

Why does this study matter to an orthopaedic surgeon?

Synovitis is common in patients with rotator cuff tears and may be associated with greater pain. This raises a practical question: does removing the synovium during cuff repair help pain settle sooner and improve shoulder function?

Study design

This prospective randomised controlled trial included 60 patients with full-thickness rotator cuff tears. Thirty underwent arthroscopic repair with synovectomy and 30 underwent repair alone. Outcomes were assessed before surgery and at three months, with assessors blinded to group allocation.

The primary outcome was worst pain at three months, measured on a 10-cm visual analogue scale (VAS). Other pain measures, range of motion, rotator cuff strength, functional scores and patient satisfaction were also assessed.

Main findings

Pain decreased substantially in both groups, but the difference between repair with and without synovectomy was not significant. The between-group comparison of the change in worst VAS pain yielded P = 0.79.

At three months, there were also no significant between-group differences in other pain measures, range of motion, rotator cuff strength, functional outcomes or overall satisfaction. Supraspinatus strength decreased significantly from baseline only in the control group; however, the difference in strength change between the groups was still not statistically significant.

Implications for practice

The findings do not support routine synovectomy solely to improve early pain or function after rotator cuff repair. An additional operative step should offer a demonstrable benefit, particularly when it extends the procedure.

This does not exclude synovectomy for other indications, such as primary synovial disease or diagnostic and technical reasons. The trial assessed synovectomy specifically as a routine addition to full-thickness cuff repair.

Limitations

• Only 60 patients were included.
• The principal assessment was at three months, so the study does not establish long-term effects.
• The findings cannot be extrapolated to other synovial disorders or other shoulder operations.

What the study does not establish

It does not show that synovectomy has no value in any setting. It shows that, in this population and for this indication, it provided no additional short-term improvement over rotator cuff repair alone.

References

Kim DM, Cho JW, Oh S, Jo CH. The Efficacy of Synovectomy in Rotator Cuff Repair: A Randomized Controlled Trial. Orthop J Sports Med. 2026;14(8):23259671261474635. DOI: 10.1177/23259671261474635. PMID: 42630550.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.