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General Orthopaedics

Anatomy Of Rotator Cuff Insertion

The South African Orthopaedic Association (SAOA) 57th Annual Congress



Abstract

Purpose:

To determine the insertion of the different layers of the rotator cuff and apply it to rotator cuff tears. Anatomical insertion of the rotator cuff holds the key to a proper anatomical repair.

Method:

A study of the rotator cuff insertion was done in conjunction with MSc student department Anatomy. The rotator cuff consists of a capsular and tendinous layer. They have different mechanical properties. The capsular layer inserts ± 3 mm more medially on the tuberosity and the tendinous layer more laterally. It was shown that the superficial layer extends beyond the greater tuberosity and connects the supra-spinatus tendon to the sub-scapularis tendon via the bicepital groove. This connection was called the “rotator hood”. The “rotator hood” has a mechanically advantageous insertion, is a strong structure with a compressive force on the proximal humerus.

Conclusion:

  1. 1.

    The rotator cuff inserts on the greater tuberosity as two separate entities.

  2. 2.

    The capsular layer inserts on the more medial 2–3 mm.

  3. 3.

    The tendinous layer is attached over a broader more lateral area giving it a mechanical advantage.

  4. 4.

    The tendinous layer of supra-spinatus extends beyond the tuberosity to connect to the sub-scapularis tendon providing an even greater mechanical advantage.