A Mechanistic Classification for Superior Labral Injuries Guides Operative Management.

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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: D.C.T. is a board or committee member of the American Orthopaedic Society for Sports Medicine; has received other financial or material support from Arthrex, Breg, DJOrtho, Mitek, and Smith & Nephew; has received IP royalties from DePuy, A Johnson & Johnson Company; and has received research support from Smith & Nephew. B.C.L. is a board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America, has received research support from Arthrex and Wright Medical Technology, and is a paid consultant for Miach and DePuy, A Johnson & Johnson Company. T.L. is a board or committee member of the Arthroscopy Association of North America, is a paid presenter or speaker for Lima, is a paid consultant for Lima and Stryker, has received other financial or material support from Lima, and has received research support from Arthrex and Wright Medical Technology. J.R.W. is a board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America, is a paid presenter or speaker for Arthrex and Vericel, is a paid consultant for Geistlich, is a member of the editorial or governing board for Ortho Info, and has stock or stock options with Viewf. C.S.K. has received consultation or advisory fees from Acumed, Restore3d, and Smith & Nephew and has stock or stock options with GE Healthcare, Johnson & Johnson, Merck, and Pfizer. J.F.D. is a board member of the AAOS, American Journal of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Society of Military Orthopaedic Surgeons. A.P.T. is a board or committee member of AAOS and the American Orthopaedic Society for Sports Medicine and has received other financial or material support from Arthrex, Breg, Mitek, Smith & Nephew, and Stryker. All other authors (E.T.H., J.T-K., S.G.L., B.S.C., Z.W.H., A.M.M., J.M.L., L.E.M., T.R.D., K.E.B.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 8. Arthroscopy. 2025 Jul;41(7):2269-2270. doi: 10.1016/j.arthro.2025.02.022. Epub 2025 Feb 26. Editorial Commentary: Tension of the Repair During Rotator Cuff Surgery Appears to Matter More Than Medial-Lateral Footprint Coverage. Xiao M, Abrams GD. The ideal rotator cuff repair construct has low tension, maximizes footprint coverage, is biomechanically strong, and optimizes tendon-to-bone healing. However, these principles are not always feasible, especially with larger tear patterns and poor tendon quality, factors that are also associated with higher retear rates. There is a constant effort with often opposing priorities to achieve a tension-free rotator cuff repair while also achieving maximal footprint coverage. This is not always possible, and there are few data to guide surgeons on which factor-tension-free repair or footprint coverage-should be prioritized. Recent studies have reported that achieving a tension-free repair with incomplete medial-to-lateral footprint coverage leads to similar functional and radiographic outcomes to complete footprint coverage using a transosseous-equivalent repair with bone marrow stimulation. Many factors affect rotator cuff tendon-to-bone healing, most notably tear size and retraction, tendon quality/preoperative fatty infiltration, repair construct, patient age, and medical comorbidities. In terms of these factors, achieving a tension-free repair and achieving maximal footprint coverage are some of the only factors we can control during surgery. However, although we may be able to pull the torn tendon edge all the way over to the lateral aspect of the footprint during our reduction maneuver, we know that fixing the tendon in this location creates a significant risk of a type 2 retear due to high tension. In the end, achieving a tension-free repair is probably the most important factor during rotator cuff repair-even if it comes at the cost of a smaller amount of medial-to-lateral footprint coverage. Copyright © 2025 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.arthro.2025.02.022