Rotator Cuff Healing Index (RoHI) Calculator

The Rotator Cuff Healing Index (RoHI) is a 15-point scoring system published by Kwon et al. in the American Journal of Sports Medicine in 2019 to predict rotator cuff healing after surgical repair.

It was derived from 603 patients who had magnetic resonance imaging or computed tomographic arthrography at least 12 months after primary rotator cuff repair by a single surgeon. The mean age at surgery was 60 years, and the overall healing failure rate was 24%.

In Kwon's derivation cohort, six factors independently predicted healing failure and were weighted according to multivariate-analysis odds ratios.

Kwon measured AP tear size at the lateral edge of the footprint, retraction intraoperatively from the lateral margin of the cuff tendon to the lateral end of the footprint, and fatty infiltration using Goutallier grading on preoperative MRI.

Using MRI retraction substitutes a different measurement method; this paper does not quantify its agreement with the intraoperative measurement.

Kwon used preoperative DXA, or DXA performed for other reasons within one year after surgery when preoperative results were unavailable.

BMD was measured in 516 of 603 patients; Kwon used multiple imputation for missing BMD when applying the score to the cohort.

Kwon reported ≤4, ≥5 and ≥10 thresholds; the ≥10 group is included in the ≥5 group.

RoHI estimates the risk of healing failure only; it does not choose a treatment.

Kwon cautioned that RoHI should not be used ‘as a means of refusing treatment because of a low healing rate’.

In 133 Thai patients, original RoHI had an AUC of 0.780 (95% CI 0.686–0.875); age, BMD and infraspinatus fatty infiltration were not independent predictors in that cohort.

Manop 2023 proposed an 11-point modified score using BMI, work activity, AP tear size and retraction, without BMD, which may be useful where BMD is not routinely obtained (full text).

In a retrospective study, RoHI discrimination for retears among 659 patients undergoing primary arthroscopic rotator cuff repair without patch augmentation was AUC 0.774 (95% CI 0.719–0.828), with an optimal cutoff of 7 in that cohort (Kim 2026).

In a retrospective series of 94 patients, mean 2-year ASES and UCLA scores did not differ statistically across groups defined using modified RoHI scores (Chan and Kejriwal, online 2025; issue 2026).

In Kim's retrospective study, among patients with RoHI ≥7, acellular dermal matrix patch augmentation was associated with a lower cumulative retear rate than repair alone (21.6% vs 36.6%), while short-term range of motion and clinical outcome scores did not differ significantly (Kim 2026).

In Cummins and Murrell's revision-surgery series, tendon pull-through was the observed failure mechanism in 19/22 revision cases (86%).

What is the RoHI score?

The Rotator Cuff Healing Index (RoHI) is a 15-point scoring system published by Kwon et al. in the American Journal of Sports Medicine in 2019 to predict rotator cuff healing after surgical repair. It was derived from 603 patients who had magnetic resonance imaging or computed tomographic arthrography at least 12 months after primary rotator cuff repair by a single surgeon.

How is the RoHI calculated?

Six factors are scored and added: tendon retraction (0, 1, 2 or 4 points for less than 1 cm, 1 to less than 2 cm, 2 to less than 3 cm, or 3 cm or more), infraspinatus fatty infiltration of Goutallier grade 2 or higher (3 points), and 2 points each for an anteroposterior tear size greater than 2.5 cm, age older than 70 years at surgery, a T-score of −2.5 or lower, and heavy manual labor.

What does a RoHI score mean?

In Kwon's derivation cohort, observed healing failure was 23/382 (6.0%) for scores ≤4, 32/99 (32.3%) for 5–6, 40/64 (62.5%) for 7–9 and 50/58 (86.2%) for ≥10. These four display bands are Radikulus groupings of Kwon 2019 Table 4. Kwon reported ≤4, ≥5 and ≥10 thresholds; the ≥10 group is included in the ≥5 group. For scores ≥5, observed healing failure was 122/221 (55.2%). These are cohort observations, not individual predictions. Kwon cautioned that RoHI cannot accurately predict individual treatment results. RoHI estimates the risk of healing failure only; it does not choose a treatment.

Can the RoHI be calculated without a bone density (DXA) result?

Not as a single complete score. Manop 2023 proposed an 11-point modified score using BMI, work activity, AP tear size and retraction, without BMD, which may be useful where BMD is not routinely obtained. This is a separate model; this calculator implements Kwon's original 15-point RoHI.