This review organizes posterosuperior rotator cuff tears by three-dimensional pattern rather than size alone. It links each of the four common patterns to a specific repair technique and expected prognosis. It also weighs the single-row versus double-row debate using level I evidence.
When you look at a cuff tear, stop thinking only in terms of small/medium/large. Think in three dimensions: where does the tear extend, and which margins are mobile? That pattern dictates technique. A crescent tear reduces straight to bone. A U/V or L tear extends medially and has no lateral mobility, so you must use margin convergence first, or the mid-tendon will overload and fail.
The single-row versus double-row debate is the high-yield controversy here. Double-row heals better structurally (single-row has 76% more imaging re-tears), but level I trials show equal clinical scores at 2 years.
The authors' key teaching point: 2 years may be too short. Asymptomatic re-tears take longer than that to become symptomatic, so structural superiority may still matter clinically over time. Use double-row (typically knotted or knotless transosseous-equivalent) for most tears, reserving single-row for partial, small, or very massive immobile tears.
This review organizes posterosuperior rotator cuff tears by three-dimensional pattern rather than size alone. It links each of the four common patterns to a specific repair technique and expected prognosis. It also weighs the single-row versus double-row debate using level I evidence.
When you look at a cuff tear, stop thinking only in terms of small/medium/large. Think in three dimensions: where does the tear extend, and which margins are mobile? That pattern dictates technique. A crescent tear reduces straight to bone. A U/V or L tear extends medially and has no lateral mobility, so you must use margin convergence first, or the mid-tendon will overload and fail.
The single-row versus double-row debate is the high-yield controversy here. Double-row heals better structurally (single-row has 76% more imaging re-tears), but level I trials show equal clinical scores at 2 years.
The authors' key teaching point: 2 years may be too short. Asymptomatic re-tears take longer than that to become symptomatic, so structural superiority may still matter clinically over time. Use double-row (typically knotted or knotless transosseous-equivalent) for most tears, reserving single-row for partial, small, or very massive immobile tears.