Rotator Cuff Tears at the Musculotendinous Junction: Classification and Surgical Options for Repair and Reconstruction

Abstract

Although uncommon, rotator cuff tears that occur medially at the musculotendinous junction can result from acute trauma, anatomic force imbalance, or medial row cuff failure following a previous rotator cuff repair. The quality of the torn muscle and tendon along with the length of the remnant tendon stump should be considered before deciding on the most appropriate repair technique. When muscle and tendon quality are sufficient, the tear can often be repaired directly to the remnant tendon stump and compressed onto the greater tuberosity. If the remnant tendon stump is degenerative, of insufficient length, or lacks tendon in which to place sutures, an allograft patch can be used to augment the repair. When the quality of the remaining muscle and tendon are poor or when the muscle is retracted too far medially and is nonmobile, a bridging technique such as superior capsule reconstruction is preferable. The purpose of this report is to (1) highlight that medial cuff failure can occur both primarily and after previous repair; (2) define and classify the 3 major tear patterns that are encountered, and (3) describe the authors' preferred techniques for medial cuff repair that specifically address each of the major tear patterns.

Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial

“…Type 2 repair failure can be related to poor shoulder function, pain, and impingement. 19 Moreover, revision surgery of type 2 retears might be technically challenging 1 because of the small amount of remaining tendon stock for repair. Therefore, the knot-tying SB RCR technique might result in serious clinical difficulties by causing strangulation of medial rotator cuff tissue, impairing vascular flow, and consequently causing necrosis of the rotator cuff and medial repair failure.…”

“…[3][4][5]31 Type 2 (medial) retears can cause impingement and are associated with pain and lower shoulder function and quality of life. 19,30 Moreover, revision of type 2 failure is more challenging. 1 Therefore, an SB RCR technique that uses knotless medial-row anchors has been developed to avoid overtensioning of the suture-tendon junction at the medial row and improve vascular inflow.…”

Tendon Healing Progression Evaluated With Magnetic Resonance Imaging Signal Intensity and Its Correlation With Clinical Outcomes Within 1 Year After Rotator Cuff Repair With the Suture-Bridge Technique

“…6,25,49,50 This indicates that the tendon itself also needs to go through postoperative recovery. 24,36 The musculotendinous changes during the recovery process, such as inflammation, tendinitis, or preexisting tendinosis, might be related to pain, dysfunction, and potential failure of healing after RCR. 5,20,32,54 Magnetic resonance imaging (MRI) is widely used for evaluating tendon structural integrity and musculotendinous changes.…”

Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying After Suture-Bridge Lateral Row Rotator Cuff Repair

“…Type 2 failures can cause impingement, severe pain, and devastating effects on shoulder function and quality of life. 19 The results of this study also indicated that shoulders with type 2 failure had inferior outcomes compared with shoulders with successful repair or type 1 failure, although the differences in the clinical scores were relatively small. Considering the difficulties of revision surgery for type 2 failures in addition to the effect on symptoms and function, it is important for surgeons to elaborate on repair techniques to decrease type 2 failure.…”