Arginine L-alpha-ketoglutarate, methylsulfonylmethane, hydrolyzed type I collagen and bromelain in rotator cuff tear repair: a prospective randomized study

Curr Med Res Opin. 2012 Nov;28(11):1767-74. doi: 10.1185/03007995.2012.737772. Epub 2012 Oct 19.


Objective: Arthroscopic rotator cuff repair generally provides satisfactory result, in terms of decreasing shoulder pain, resulting in improvement in range of motion. Unfortunately, imaging studies have shown that after surgical repair re-rupture rate is potentially high. Literature data indicate that each of the components present in a commercial supplement sold in Italy as Tenosan * (arginine L-alpha-ketoglutarate, methylsulfonylmethane, hydrolyzed type I collagen and bromelain) have a potential role in tendon healing and mitigating the pain due to tendonitis. We evaluated the clinical and MRI results of rotator cuff repair with and without the employment of this oral supplement in patients with a large, postero-superior rotator cuff tear (RCT).

Research design and methods: We enrolled 90 consecutive patients who had a large, postero-superior RCT. All the lesions were managed with an arthroscopic repair. Patients were randomized and treated either with (Group I) or without (Group II) the supplement. The primary outcomes were the difference between the pre- and post-operative Constant score and repair integrity assessed by MRI according to Sugaya's classification. The secondary outcome was the pre- and post-operative Simple Shoulder Test.

Results: No statistically significant differences were identified between the two groups for each considered variable, except for shoulder pain (follow-up: 6 months) and repair integrity (final follow-up). Intensity of shoulder pain was lower in the Group I patients (p < 0.001). Analogously, in Group I, the percentage of patients with a better repair integrity result was significantly higher than Group II.

Conclusion: The use of the supplement for 3 months after cuff repair decreases shoulder post-operative pain and leads to a slight improvement in repair integrity. This improvement does not seem to correlate with an better objective functional outcome. However, these effects could facilitate and abbreviate the post-operative rehabilitation program and reduce re-rupture rate. The main limitations of this study are the relative short follow-up period and small number of patients studied.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arginine / analogs & derivatives*
  • Arginine / pharmacology
  • Arginine / therapeutic use
  • Bromelains / pharmacology*
  • Bromelains / therapeutic use
  • Collagen Type I / pharmacology*
  • Collagen Type I / therapeutic use
  • Dimethyl Sulfoxide / pharmacology*
  • Dimethyl Sulfoxide / therapeutic use
  • Female
  • Humans
  • Hydrolysis
  • Ketoglutaric Acids / pharmacology*
  • Ketoglutaric Acids / therapeutic use
  • Male
  • Middle Aged
  • Prospective Studies
  • Rotator Cuff Injuries*
  • Shoulder Impingement Syndrome / drug therapy*
  • Sulfones / pharmacology*
  • Sulfones / therapeutic use
  • Wound Healing / drug effects*


  • Collagen Type I
  • Ketoglutaric Acids
  • L-arginine alpha-ketoglutarate
  • Sulfones
  • Bromelains
  • Arginine
  • dimethyl sulfone
  • Dimethyl Sulfoxide