Rotator cuff surgery and semantics : definitions matter

The imprecise definition of terms used to describe pathological diagnosis in clinical medicine can lead to imprecise treatment concepts and inaccurate recording of outcomes. In this article, we explore the meaning of common terms applied to the pathology of the rotator cuff, and demonstrate how the imprecise use of words entails a risk of leading to a poor definition of the clinical condition being treated. We suggest improvements in the accuracy of the definition of what constitutes the rotator cuff. We suggest the use of 'defect' to describe the most common presentation of a degenerative lesion of the rotator cuff, rather than perpetuate the use of the term 'tear', which has a different, injurious aetiology. We suggest that the term 'repair' should be reserved for the condition in which an acutely injured tendon (with a 'tear') can be expected to heal, using the correct definition of the term 'to heal'. We recommend reserving the use of the term 'healed' for the condition of an acute lesion of the rotator cuff (a 'tear') to which the histological process of regenerating a near-normal enthesis can be reasonably applied. We further suggest that degenerative lesions ('defects') of the rotator cuff, which do not have the biological capacity to heal in the true sense when brought back to bone, should be described as having 'closure' of the defect.