This prospective cohort reports 2- to 4-year outcomes after complete arthroscopic repair of 37 massive rotator cuff tears. It compares anterosuperior (subscapularis-involving) tears against posterosuperior tears. The question: does specifically addressing the subscapularis and medial bicipital sheath equalize outcomes between these two tear patterns?
When you see a massive tear that includes the subscapularis, don't assume it is doomed to a worse result. The historical teaching was that anterosuperior tears fare worse than posterosuperior ones. This paper argues the difference is explained by a missed "hidden" interval lesion: an unrepaired subscapularis and disrupted medial bicipital sheath allowing biceps subluxation.
Address the subscapularis and reconstruct the medial sheath, and outcomes equalize. The second lesson is that anatomic coverage and clinical success are not the same thing. Only 78% got complete coverage, but 95% were satisfied, and force-couple partial repairs relieved pain by restoring the rotator cable.
Keep the appraisal honest: this is a single-surgeon, non-randomized, unblinded series of 37 patients with only 8 PS tears, so the between-group "equivalence" is underpowered. Treat it as technique-generating evidence, not a definitive comparison.
This prospective cohort reports 2- to 4-year outcomes after complete arthroscopic repair of 37 massive rotator cuff tears. It compares anterosuperior (subscapularis-involving) tears against posterosuperior tears. The question: does specifically addressing the subscapularis and medial bicipital sheath equalize outcomes between these two tear patterns?
When you see a massive tear that includes the subscapularis, don't assume it is doomed to a worse result. The historical teaching was that anterosuperior tears fare worse than posterosuperior ones. This paper argues the difference is explained by a missed "hidden" interval lesion: an unrepaired subscapularis and disrupted medial bicipital sheath allowing biceps subluxation.
Address the subscapularis and reconstruct the medial sheath, and outcomes equalize. The second lesson is that anatomic coverage and clinical success are not the same thing. Only 78% got complete coverage, but 95% were satisfied, and force-couple partial repairs relieved pain by restoring the rotator cable.
Keep the appraisal honest: this is a single-surgeon, non-randomized, unblinded series of 37 patients with only 8 PS tears, so the between-group "equivalence" is underpowered. Treat it as technique-generating evidence, not a definitive comparison.