Retrospective Level III comparison of two ways to fix large, chronically retracted rotator cuff tears. One group had the tendon reattached to its anatomic footprint on the greater tuberosity. The other had the footprint medialized onto the decorticated humeral head when the tendon could not reach without tension. All repairs used a double-row modified Mason-Allen technique, with MRI to assess healing.
When a large retracted tendon will not reach the greater tuberosity, your instinct may be to pull harder and fix it anatomically. This paper argues the opposite. A tension-free repair medialized onto the humeral head healed better than a tight anatomic repair, cutting retears from 31% to 8%, with equal clinical scores at 1 to 2 years.
The key rule to carry is the distance. Cadaveric data show the supraspinatus moment arm and ROM drop off past about 17 mm of medialization, so keep it near 10 mm. The 3.4-mm ring curette gives a quick intraoperative gauge at roughly three curette-widths.
Weigh the patient in front of you. Medialization greater than 10 mm restricts motion and is a poor choice for young or high-demand shoulders that need full abduction, but it is a reasonable tension-reducing option in older, lower-demand patients where healing matters more than the last few degrees of ROM.
Retrospective Level III comparison of two ways to fix large, chronically retracted rotator cuff tears. One group had the tendon reattached to its anatomic footprint on the greater tuberosity. The other had the footprint medialized onto the decorticated humeral head when the tendon could not reach without tension. All repairs used a double-row modified Mason-Allen technique, with MRI to assess healing.
When a large retracted tendon will not reach the greater tuberosity, your instinct may be to pull harder and fix it anatomically. This paper argues the opposite. A tension-free repair medialized onto the humeral head healed better than a tight anatomic repair, cutting retears from 31% to 8%, with equal clinical scores at 1 to 2 years.
The key rule to carry is the distance. Cadaveric data show the supraspinatus moment arm and ROM drop off past about 17 mm of medialization, so keep it near 10 mm. The 3.4-mm ring curette gives a quick intraoperative gauge at roughly three curette-widths.
Weigh the patient in front of you. Medialization greater than 10 mm restricts motion and is a poor choice for young or high-demand shoulders that need full abduction, but it is a reasonable tension-reducing option in older, lower-demand patients where healing matters more than the last few degrees of ROM.