What Type of Rotator Cuff Tear Is This? Tear Pattern Recognition and Soft-Tissue Releases

Chapter 16

What Type of Rotator Cuff Tear Is This? Tear Pattern Recognition and Soft-Tissue Releases

Jarret M. Woodmass, Devin Lemmex, Yohei Ono, and Ian K.Y. Lo


Rotator cuff tears are classically described as crescent-shaped, U-shaped, L-shaped, reverse L-shaped, and massive contracted immobile tears. Tear pattern recognition is critical to ensuring anatomic repair of the rotator cuff, restoring and balancing the force couples about the shoulder, and reestablishing a normal glenohumeral fulcrum of motion. Crescent-shaped tears have excellent medial-to-lateral mobility and can be repaired directly to bone. U- and L-shaped tears require side-to-side sutures prior to tendon-to-bone fixation. Massive contracted rotator cuff tears are more technically challenging, often requiring extensive soft-tissue releases to achieve a tension-free repair to bone. These releases may include an intracapsular (or intraarticular) release, anterior or posterior interval slides, and releases specifically for the subscapularis tendon.


Following diagnostic arthroscopy, a bursal resection is performed, exposing the tear margins. The mobility of the tendon is assessed, and the tear pattern is established. If a full-thickness subscapularis tear is present, this is addressed first by identifying the “comma sign” and performing subscapularis releases and repair. Although most posterosuperior tears can be repaired with standard mobilization techniques (i.e., bursal resection, intracapsular release) and by understanding the tear pattern, interval slides (e.g., a posterior interval slide, anterior interval slide, interval slide in continuity, or combination) may be used to obtain a tension-free repair in massive contracted immobile tears.

Patient History

Patient Examination


Treatment Options: Nonoperative and Operative

Surgical Anatomy

Surgical Indications

Surgical Technique Setup



Surgical Exposure/Portals

Short Description of the Surgical Exposure

Video 16.1: Subscapularis soft tissue releases (anterior, superior, posterior) and tendon mobilization.

Step-by-Step Guide to Surgical Technique

Step 1


  1. • Subscapularis tendon releases (Video 16.1).
  2. • A standard posterior glenohumeral portal is established, and a diagnostic arthroscopy is performed.
  3. • If a subscapularis tear is identified, then subscapularis releases and tendon repair are performed prior to addressing the posterosuperior rotator cuff.

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Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on What Type of Rotator Cuff Tear Is This? Tear Pattern Recognition and Soft-Tissue Releases

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