Delaminated Rotator Cuff Tears

» Delaminated rotator cuff tears (DRCTs) represent a unique type of tear characterized by horizontal splits within the supraspinatus tendon, occurring in both partial-thickness and full-thickness tears, with or without retraction of the bursal or articular surfaces.» The pathogenesis of DRCTs lies in the anatomical layered architecture of the supraspinatus and infraspinatus tendons and the interlayer shear stress disparities. Furthermore, during shoulder abduction, hypovascular-driven degeneration and biomechanical strain gradients also contribute to this layered pathogenesis.» Accurate diagnosis of DRCTs mainly relies on imaging methods such as magnetic resonance imaging, magnetic resonance arthrography, and ultrasonography. Recent advances in shear wave elastography have enhanced diagnostic accuracy by delineating tear morphology and quantifying tendon stiffness.» Management of DRCTs requires individualized strategies based on tear size, muscle quality, and chronicity. Nonoperative approaches, including activity modification, nonsteroidal anti-inflammatory drugs, and targeted physiotherapy, may be considered for acute partial-thickness DRCTs. Surgical repair becomes necessary for chronic, severely retracted, or full-thickness DRCTs, as well as for cases where nonoperative treatments have failed to achieve satisfactory outcomes, using either en masse or dual-layer techniques.» Although en masse and dual-layer repairs show comparable clinical outcomes and retear rates, dual-layer repair demonstrates superior pain control and functional recovery, making it a preferred surgical approach.