Patte proposes a five-parameter anatomic classification for rotator cuff tears, developed from 25 years of operative experience and 223 consecutive repairs. The classification addresses extent (Groups I–IV), sagittal topography (Segments 1–6), frontal retraction (Stages 1–3), muscle trophic quality, and LHB status. The goal: enable meaningful comparison of outcomes across surgical series that had previously used incompatible, size-only schemes.
Before Patte's classification, surgical series compared outcomes using only the greatest tear diameter — a measurement Patte shows is inaccurate because infraspinatus posterior sliding artificially enlarges the apparent gap.
When you evaluate a rotator cuff tear preoperatively, size alone is not enough. Ask: which sagittal segment is involved? How far has the stump retracted in the frontal plane? What does CT show about muscle fat content? Is the LHB intact in a massive tear?
Frontal Stage 3 retraction is a direct surgical decision point: if the stump is at the glenoid, plan for a plastic procedure. Primary reattachment will not be possible. In massive (Group III) tears, a disrupted LHB is not incidental. It removes a secondary check on superior head migration and should factor into your prognostic conversation with the patient.
The CT-based fatty degeneration staging described here became the foundation for the Goutallier classification. One of the most referenced prognostic tools in rotator cuff surgery today.
Patte proposes a five-parameter anatomic classification for rotator cuff tears, developed from 25 years of operative experience and 223 consecutive repairs. The classification addresses extent (Groups I–IV), sagittal topography (Segments 1–6), frontal retraction (Stages 1–3), muscle trophic quality, and LHB status. The goal: enable meaningful comparison of outcomes across surgical series that had previously used incompatible, size-only schemes.
Before Patte's classification, surgical series compared outcomes using only the greatest tear diameter — a measurement Patte shows is inaccurate because infraspinatus posterior sliding artificially enlarges the apparent gap.
When you evaluate a rotator cuff tear preoperatively, size alone is not enough. Ask: which sagittal segment is involved? How far has the stump retracted in the frontal plane? What does CT show about muscle fat content? Is the LHB intact in a massive tear?
Frontal Stage 3 retraction is a direct surgical decision point: if the stump is at the glenoid, plan for a plastic procedure. Primary reattachment will not be possible. In massive (Group III) tears, a disrupted LHB is not incidental. It removes a secondary check on superior head migration and should factor into your prognostic conversation with the patient.
The CT-based fatty degeneration staging described here became the foundation for the Goutallier classification. One of the most referenced prognostic tools in rotator cuff surgery today.