Davidson and Burkhart propose a four-type geometric classification of complete supraspinatus, infraspinatus, and teres minor tears. The system uses T2-weighted MRI measurements in the coronal (length) and sagittal (width) planes to predict tear shape, dictate repair technique, and forecast outcome. It directly addresses the failure of older linear-size and tendon-count systems to guide surgical decision-making.
When you look at a rotator cuff MRI before a repair, the question is not just "how big is it?" — it is "what shape is it, and which technique does that shape demand?"
Measure L on the T2 coronal view and W on the T2 sagittal view. If L ≤ W and L < 2 cm, plan an end-to-bone repair. If L > W and W < 2 cm, plan margin convergence. If both dimensions hit 2 cm, assume you will need interval slides in most cases. If both hit 3 cm, you will definitely need them.
For fatty degeneration: >75% means fair/unpredictable results. Counsel the patient honestly but do not automatically refuse surgery. At 50–75%, outcomes are good and 86% of patients improve, which is better than the Goutallier framework alone would suggest.
T2-weighted sequences are the right tool for this assessment. The intact cuff is dark; the tear is bright. Always evaluate both coronal and sagittal views. A tear can appear deceptively massive on a single plane.
Davidson and Burkhart propose a four-type geometric classification of complete supraspinatus, infraspinatus, and teres minor tears. The system uses T2-weighted MRI measurements in the coronal (length) and sagittal (width) planes to predict tear shape, dictate repair technique, and forecast outcome. It directly addresses the failure of older linear-size and tendon-count systems to guide surgical decision-making.
When you look at a rotator cuff MRI before a repair, the question is not just "how big is it?" — it is "what shape is it, and which technique does that shape demand?"
Measure L on the T2 coronal view and W on the T2 sagittal view. If L ≤ W and L < 2 cm, plan an end-to-bone repair. If L > W and W < 2 cm, plan margin convergence. If both dimensions hit 2 cm, assume you will need interval slides in most cases. If both hit 3 cm, you will definitely need them.
For fatty degeneration: >75% means fair/unpredictable results. Counsel the patient honestly but do not automatically refuse surgery. At 50–75%, outcomes are good and 86% of patients improve, which is better than the Goutallier framework alone would suggest.
T2-weighted sequences are the right tool for this assessment. The intact cuff is dark; the tear is bright. Always evaluate both coronal and sagittal views. A tear can appear deceptively massive on a single plane.