title: The Rotator Cuff and the Superior Capsule: Why We Need Both.
abstract: Tears of the rotator cuff are frequent. An estimated 250,000 to 500,000 repairs are performed annually in the United States. Rotator cuff repairs have been successful despite fatty infiltration and atrophy of the rotator cuff muscles. Although the emphasis in rotator cuff repair has historically focused on re-establishing the tendon attachment, there is growing interest in and understanding of the role of the superior capsule. The superior capsule is attached to the undersurface of the supraspinatus and infraspinatus muscle-tendon units, and it resists superior translation of the humeral head. Herein, we propose that it is the defect in the superior capsule that is the "essential lesion" in a superior rotator cuff tear, as opposed to the defect in the rotator cuff itself. We propose that rotator cuff repair must restore the normal capsular anatomy to provide normal biomechanics of the joint and thus a positive clinical outcome.
authors.affiliation: Department of Orthopedic Surgery, Naples Community Hospital, Naples, Florida, U.S.A.; Department of Medical Education, Arthrex, Naples, Florida, U.S.A.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Adams
authors.affiliation: Department of Medical Education, Arthrex, Naples, Florida, U.S.A.
authors.forename: Angelica M
authors.initials: AM
authors.lastname: DeMartino
authors.affiliation: Department of Medical Education, Arthrex, Naples, Florida, U.S.A.
authors.forename: George
authors.initials: G
authors.lastname: Rego
authors.affiliation: Department of Orthopaedic Surgery, Southern Oregon Orthopedics, Medford, Oregon, U.S.A.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: Department of Orthopaedic Surgery, The San Antonio Orthopaedic Group, San Antonio, Texas, U.S.A.; Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.. Electronic address: v_ruelas@yahoo.com.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Burkhart
mesh_terms: D001178:Arthroplasty; D001182:Arthroscopy; D006801:Humans; D058430:Humeral Head / Q000502:physiology; D017746:Joint Capsule / Q000293:injuries* / Q000502:physiology / Q000503:physiopathology / Q000601:surgery; D017006:Rotator Cuff / Q000502:physiology / Q000601:surgery; D000070636:Rotator Cuff Injuries / Q000503:physiopathology* / Q000601:surgery; D012785:Shoulder Joint / Q000502:physiology / Q000503:physiopathology*; D013710:Tendons