Evolving concepts in the rotator cuff footprint

Rotator cuff (RC) tears are a common presentation in day-to-day clinical settings. Majority of the symptomatic patients are treated by a surgical repair. Before considering a surgical intervention, it is vital to understand the anatomy of RC footprint and restore it, in order to achieve an optimal tension-free repair, better healing and subsequently good clinical outcomes. Concepts pertaining to the RC footprint over the greater tuberosity (GT) have been constantly changing in the past two decades with meticulous anatomical studies. Traditional concepts of individual insertions of supraspinatus (SSP) and infraspinatus (ISP), SSP alone playing the vital role in shoulder abduction, now stand obsolete. Similarly, being the largest muscle-tendon unit, subscapularis (SSC) has been studied extensively and is now known to have a three dimensional insertion over lesser tuberosity. This article reviews the evolution of concepts pertaining to RC insertion and their clinical application. Keywords: Rotator cuff; Footprint; Three-dimensional insertion.