Editorial Commentary: Tension of the Repair During Rotator Cuff Surgery Appears to Matter More Than Medial-Lateral Footprint Coverage.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.X. is on the editorial or governing board of Arthroscopy. G.D.A. is a board or committee member of American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; is on the editorial or governing board of Arthroscopy; receives other financial or material support from Arthrex and Stryker; is a paid consultant for Cytonics, Fidia Pharma, RubiconMD, and Sideline Sports Doc; owns stock or stock options in Cytonics; is an unpaid consultant for TeachAIDS; receives royalty or license payments from Orthofix Medical: and receives educational support from Evolution Surgical. 9. Arthroscopy. 2025 Oct;41(10):4367-4378. doi: 10.1016/j.arthro.2025.03.059. Epub 2025 Jun 9. A Mechanistic Classification for Superior Labral Injuries Guides Operative Management. Hurley ET(1), Taylor DC(2); Duke Superior Labral Injury Study Group(2); Duke Superior Labral Tear Study Group includes(2); Twomey-Kozak J(2), Lorentz SG(2), Crook BS(2), Hinton ZW(2), Meyer AM(2), Levin JM(2), Meyer LE(2), Doyle TR(2), Bradley KE(2), Lau BC(2), Lassiter T(2), Wittstein JR(2), Klifto CS(2), Dickens JF(2), Toth AP(2). Author information: (1)Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.. Electronic address: eoghan.hurley@duke.edu. (2)Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A. The purpose of this article is to provide a clinically oriented classification system for superior labral injuries based on etiology, pathoanatomy, and associated biceps-labrum anchor complex injuries. The proposed classification system is based primarily on the mechanism of superior labral injuries as an ABCD classification (A, acute trauma; B, Bankart extension from instability; C, chronic repetitive overhead activity; and D, degenerative). The recognition of the cause is paramount to appropriately treating these patients, especially when considering operative treatment. Traumatic injuries include compressive loads, axial traction, or torsional loading and can also be secondary to shoulder instability events. Chronic overuse-related superior labral injuries typically occur with repetitive overhead activities, most commonly throwing mechanisms in athletes. Degenerative changes to the superior labrum are related to normal aging processes and are often identified during evaluation and management of other conditions (e.g., rotator cuff tears). Superior labral anatomic variants may also be present that may alter labral loading. Nonoperative management is often an appropriate and effective initial treatment for superior labral injuries, unless there are obvious pathologic changes altering the mechanics of the glenohumeral joint (large labral flap tears, bucket handle tears, etc.) or other associated injuries (traumatic rotator cuff tears, fractures, etc.). Surgical treatment principles include (1) preserving normal mobility of the superior labrum/biceps tendon complex; (2) when detached, repairing the normally fixed inferior labrum anteriorly and posteriorly; (3) considering biceps tenotomy or tenodesis when pathologic changes extend into the long head of the biceps tendon; and (4) considering individual patient factors in each case. In addition to these general principles, the classification guides operative treatment. LEVEL OF EVIDENCE: Level V, expert opinion. Copyright © 2025 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.arthro.2025.03.059