Irreparable rotator cuff tears: a novel classification system.

Background Irreparable rotator cuff tears can be man- aged by several approaches. However, current tear classi- fications fail to reflect the wide variety of their presentation, which has important clinical and prognostic implications. Methods We describe a novel classification system based on preoperative imaging findings and intraoperative observation where each cuff tendon (numbered sequen- tially: 1-supraspinatus, 2-infraspinatus, 3-teres minor, and 4-subscapularis) is assessed intraoperatively for reducibil- ity to the footprint; tendons with reparable lesions are assessed for fatty degeneration (which predicts healing potential) and given a plus if degeneration is\50 % (Fuchs stage I–II/Goutallier stage 0–II) or a minus if it is C50 % (Fuchs stage III/Goutallier stage III–IV). Results The proposed system (1) allows more consistent and reproducible classification of cuff tears where at least one tendon is irreparable; (2) results in more accurate diagnosis; (3) guides in treatment selection; and (4) ensures better outcomes and realistic patient expectations. R. Castricini (&) M. De Benedetto N. Orlando Department of Orthopaedic and Trauma Surgery, Casa di Cura Villa Verde, Fermo, Italy e-mail: robertocastricini@tin.it E. Gervasi Department of Orthopaedic and Trauma Surgery, Ospedale Civile, Latisana, Italy A. Castagna Unit of Shoulder Surgery, Istituto Clinico Humanitas, Rozzano, Italy Conclusions The novel classification system can con- tribute to develop increasingly exhaustive and reproducible classification models.