Prospective cohort of 86 patients undergoing arthroscopic double-row rotator cuff repair. Postoperative MRI at mean 14 months classified repair integrity using the five-type Sugaya system. Functional outcomes (JOA, UCLA, ASES) were assessed at mean 31 months.
Tear size is your single most important variable when counseling a patient before rotator cuff repair. Small-to-medium tears have a 5% structural failure rate at 14 months with double-row technique. Large and massive tears fail structurally 40% of the time — counsel these patients explicitly before surgery.
When you see a postoperative MRI with a small defect (Sugaya Type IV), do not panic and do not automatically attribute poor function to the imaging finding. Type IV repairs have functional outcomes equivalent to intact repairs. Only Type V (major discontinuity, medium/large retear) carries a meaningful functional penalty.
Before offering repair on a large or massive tear, check preoperative MRI for Goutallier stage 3-4 fatty degeneration. The authors exclude these patients from primary repair because retracted, degenerated muscle cannot be reduced to the footprint reliably.
This paper also established the Sugaya classification as the standard language for describing repair integrity on MRI. Knowing Types I through V is essential for interpreting postoperative imaging and for board examinations.
Prospective cohort of 86 patients undergoing arthroscopic double-row rotator cuff repair. Postoperative MRI at mean 14 months classified repair integrity using the five-type Sugaya system. Functional outcomes (JOA, UCLA, ASES) were assessed at mean 31 months.
Tear size is your single most important variable when counseling a patient before rotator cuff repair. Small-to-medium tears have a 5% structural failure rate at 14 months with double-row technique. Large and massive tears fail structurally 40% of the time — counsel these patients explicitly before surgery.
When you see a postoperative MRI with a small defect (Sugaya Type IV), do not panic and do not automatically attribute poor function to the imaging finding. Type IV repairs have functional outcomes equivalent to intact repairs. Only Type V (major discontinuity, medium/large retear) carries a meaningful functional penalty.
Before offering repair on a large or massive tear, check preoperative MRI for Goutallier stage 3-4 fatty degeneration. The authors exclude these patients from primary repair because retracted, degenerated muscle cannot be reduced to the footprint reliably.
This paper also established the Sugaya classification as the standard language for describing repair integrity on MRI. Knowing Types I through V is essential for interpreting postoperative imaging and for board examinations.