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How important is the anterior rotator cuff cable?: commentary on an article by Mena M. Mesiha, MD, et al.: "The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model".

There is a growing body of clinical evidence that indicates that patients can maintain relatively normal shoulder function despite a tear in the rotator cuff. This has been proven with magnetic resonance imaging studies of asymptomatic patients1 as well as clinical studies revealing unsuspected disruptions following rotator cuff repair2. Indeed, clinical series in which only partial rotator cuff repairs were performed have yielded good results despite the fact that there was a known deficiency in the rotator cuff following surgery3,4. In all of these scenarios, patients are often minimally symptomatic and maintain good shoulder function with minimal pain. There is poor correlation between cuff tear size and the degree of either pain or functional restrictions noted by the patient. This would tend to indicate that there are factors intrinsic to different types of cuff tears that lead to varying degrees of symptoms.

Burkhart et al. were the first to propose a theoretical basis for this phenomenon with the “suspension bridge” model5. They postulated that, if intact portions of the cuff anteriorly and …