Abstract

Rotator cuff tendinopathy and degenerative tears represent a leading cause of shoulder pain and disability and are associated with high failure rates after surgical repair. Emerging data have implicated non-coding RNAs, including microRNAs, long non-coding RNAs, and circular RNAs, together with epigenetic mechanisms such as DNA methylation and histone modifications, in the pathogenesis and healing potential of rotator cuff disorders. This narrative review synthesizes current evidence on these molecular regulators in human rotator cuff tissues and relevant experimental models, integrating their roles in inflammation, extracellular matrix remodelling, tenogenic differentiation, and muscle degeneration. It also explores their potential utility as biomarkers of disease severity and prognostic indicators of repair outcomes, and considers the feasibility of targeting non-coding RNAs and epigenetic pathways for regenerative therapeutics in shoulder surgery.

Keywords: Rotator cuff tendinopathy, Non-coding RNAs, MicroRNAs, Circular RNAs, Epigenetics, DNA methylation, Histone modifications, Tendon healing, Tendon degeneration