This 1965 case series by Debeyre, Patte, and Elmelik reports outcomes in 63 patients with rotator cuff tears treated via two surgical approaches. It asks whether a new postero-superior transacromial technique with supraspinatus muscle advancement produces better results than the classical deltopectoral approach.
When you encounter a chronic, widely retracted rotator cuff tear that seems inoperable through a standard anterior approach, the concept driving modern extensile exposure comes from this paper. Debeyre showed that the limiting factor was access — not tissue quality. And that elevating the supraspinatus from its fossa preserved neurovascular function while enabling closure of gaps that would otherwise be abandoned.
In practice: confirm the diagnosis with imaging before committing to surgery, and trial 4–6 months of physiotherapy first, since approximately half of patients improve spontaneously. When counseling patients preoperatively, etiology matters. Degenerative tears achieve satisfactory results 85% of the time vs 50% for traumatic tears, a difference large enough to set expectations appropriately.
The observation that lateral rotation deficits persist when the infraspinatus is involved. And that supraspinatus advancement alone will not restore it. Remains directly relevant when planning repair of massive tears today.
This 1965 case series by Debeyre, Patte, and Elmelik reports outcomes in 63 patients with rotator cuff tears treated via two surgical approaches. It asks whether a new postero-superior transacromial technique with supraspinatus muscle advancement produces better results than the classical deltopectoral approach.
When you encounter a chronic, widely retracted rotator cuff tear that seems inoperable through a standard anterior approach, the concept driving modern extensile exposure comes from this paper. Debeyre showed that the limiting factor was access — not tissue quality. And that elevating the supraspinatus from its fossa preserved neurovascular function while enabling closure of gaps that would otherwise be abandoned.
In practice: confirm the diagnosis with imaging before committing to surgery, and trial 4–6 months of physiotherapy first, since approximately half of patients improve spontaneously. When counseling patients preoperatively, etiology matters. Degenerative tears achieve satisfactory results 85% of the time vs 50% for traumatic tears, a difference large enough to set expectations appropriately.
The observation that lateral rotation deficits persist when the infraspinatus is involved. And that supraspinatus advancement alone will not restore it. Remains directly relevant when planning repair of massive tears today.