Geometric Tear Configuration Influences Intraoperative Reparability after Arthroscopic Rotator Cuff Repair

Rotator cuff (RC) tear morphology is thought to influence reparability and healing potential, yet few clinical studies have compared outcomes across distinct tear patterns. The purpose of this study was to determine whether different RC tear patterns affect reparability and retear rate following arthroscopic repair.

A retrospective analysis was conducted on 134 patients who underwent arthroscopic repair for posterosuperior RC tears between 2018 and 2022. Tears were classified arthroscopically into 5 geometric patterns-crescent, anterior L-shaped, posterior L-shaped, U-shaped, and trapezoid-based on a modified Burkhart-Davidson system. Reparability was assessed by the ability to achieve ≥ 50% footprint coverage at the time of surgery. Structural integrity was evaluated by magnetic resonance imaging at 6 months postoperatively. Additionally, a subgroup analysis was performed by matching crescent and anterior L-shaped tears based on tear size using propensity score matching.

Crescent-shaped tears were most common (47.8%), followed by anterior L-shaped (28.4%), trapezoid-shaped (11.2%), U-shaped (9.0%), and posterior L-shaped tears (3.7%). Interobserver agreement for tear pattern classification was moderate (κ = 0.634). Incomplete repair was associated with larger tear dimensions and tear pattern, with trapezoid-shaped tears demonstrating the highest rate of incomplete repair. Anterior L-shaped tears showed the lowest incomplete repair rate. Retear was associated with larger tear size, lower muscle occupation ratio, and greater fatty infiltration on univariate analysis; however, no variables remained independently associated with retear on multivariable analysis. In the propensity score-matched cohort (32 anterior L-shaped vs. 32 crescent-shaped tears), anterior L-shaped tears demonstrated a lower rate of incomplete repair (18.8% vs. 43.8%, p = 0.031), while retear rates were similar between groups.

RC tear pattern was associated with intraoperative reparability after arthroscopic repair but did not independently predict postoperative structural healing. Anterior L-shaped tears demonstrated higher reparability than crescent-shaped tears, whereas retear rates were comparable. Tear pattern recognition may assist surgical planning rather than serve as a standalone prognostic factor for tendon healing.