The rotator cuff footprint is the collective tendon insertion zone on the greater and lesser tubercles of the humerus, where the confluent cuff tendons insert in defined anatomical zones. The supraspinatus occupies the superior facet (average 12.6 mm mediolateral and 23 mm anteroposterior), infraspinatus the middle facet, and teres minor the inferior facet. Anatomical double-row rotator cuff repair aims to restore the full footprint area rather than just a single-point attachment.
Collective rotator cuff tendon bone attachment zone; the anatomical restoration target in rotator cuff repair
Double-row rotator cuff repair using medial row suture anchors at the articular margin and lateral row anchors at the greater tubercle margin restores the footprint area and produces lower re-tear rates than single-row repair in biomechanical studies. Massive cuff tears with retraction beyond the footprint require mobilisation, margin convergence, and sometimes partial repair accepting less than full footprint restoration.
Full-thickness cuff tear producing footprint denudation requiring double-row anchor repair to restore the anatomical tendon bone contact area.
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