Reconciling the paradox of rotator cuff repair versus debridement: A unified biomechanical rationale for the treatment of rotator cuff tears

Cover the hole in the Echoes from the past and voices from the present blend to give us the same message. The message is firm and authoritative, almost mesmerizing, yet almost unchanged since the time the edict was first issued by Codman (1) almost 60 years ago. We all understand the concept of rotator cuff repair. It makes sense to repair a torn rotator cuff to its anatomic location. We restore the anatomy and hence restore the mechanics of the cuff. However, when faced with a massive tear that cannot be completely repaired, most orthopedic surgeons continue to be swayed by that ancient irresistible siren song of the hole. A number of clever techniques have been used to cover the hole, including supraspinatus muscle slide (2), fascial graft (3), freeze-dried allograft (4), and tendon transposition (5,6). However, most of these techniques either ignore or openly violate the mechanics of the shoulder. A major purpose of this article is to encourage us as orthopedic surgeons to consider the multidisciplinary dimensions of a biologic problem: Too often we seek biologic solutions to mechanical problems. For years, engineers have used professional horizontal cross-integration on major projects by employing experts from diverse fields to approach complex engineering problems. This allows the engineering team to evaluate a problem from a number of different perspectives. This approach reduces the possibility of overlooking some critically important