Frequency of various tear patterns in full-thickness tears of the rotator cuff.

PURPOSE: We define specific rotator cuff tear patterns, prospectively document their occurrences, and emphasize the importance of tear pattern recognition during arthroscopy.

METHODS: We prospectively analyzed 193 full-thickness rotator cuff tears intraoperatively from a single surgeon's practice. We address specific tear patterns, tear size, tissue mobility, tissue quality, and chronicity.

RESULTS: Most of the tears were able to be categorized into 6 morphologic patterns. Of the tears, 3% could not be categorized. Appreciation of various rotator cuff tear patterns guided the positioning of bone and tissue sutures to achieve accurate apposition of tendon fibers. Transverse tears were the smallest and most common tear pattern, whereas tongue-shaped and U-shaped tears were larger patterns of comparable size. U-shaped tears had more retraction and less mobility and were of poorer tissue quality. Transverse tears were easily repaired, whereas U-shaped tears could not be repaired in 38% of cases (5/13).

CONCLUSIONS: The quality and mobility of rotator cuff tissue were correlated with tear pattern, size, retraction, and chronicity. We describe a comprehensive rotator cuff tear classification scheme that encompasses 97% of all tears. Tear type was correlated with tendon retraction, tear size, cuff mobility, and tissue quality. On the basis of this information, the surgeon can anticipate tear patterns, which may improve pattern recognition and facilitate anatomic repair.

LEVEL OF EVIDENCE: Level IV, prognostic case series.