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An estimated 250,000 to 500,000 repairs are performed annually in the United States. Rotator cuff repairs have been successful despite fatty infiltration and atrophy of the rotator cuff muscles. Although the emphasis in rotator cuff repair has historically focused on re\u2010establishing the tendon attachment, there is growing interest in and understanding of the role of the superior capsule. The superior capsule is attached to the undersurface of the supraspinatus and infraspinatus muscle\u2010tendon units, and it resists superior translation of the humeral head. Herein, we propose that it is the defect in the superior capsule that is the \u201cessential lesion\u201d in a superior rotator cuff tear, as opposed to the defect in the rotator cuff itself. We propose that rotator cuff repair must restore the normal capsular anatomy to provide normal biomechanics of the joint and thus a positive clinical outcome.<\/jats:p>","DOI":"10.1016\/j.arthro.2016.08.011","type":"journal-article","created":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T06:46:11Z","timestamp":1480574771000},"page":"2628-2637","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":150,"title":["The Rotator Cuff and the Superior Capsule: Why We Need Both"],"prefix":"10.1002","volume":"32","author":[{"given":"Christopher R.","family":"Adams","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Naples Community Hospital Naples Florida U.S.A."},{"name":"Department of Medical Education Arthrex Naples Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica M.","family":"DeMartino","sequence":"additional","affiliation":[{"name":"Department of Medical Education 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