The Arthroscopic Rotator Interval Closure: Why, When, and How?

The contribution of the rotator interval (RI) to the overall stability of the glenohumeral joint remains under debate. With improvements in the interpretation of both physical examination and diagnostic imaging findings, the diagnosis of RI pathology is becoming easier to identify. The clinical implications of RI pathology, however, still remain controversial. Injury to RI may contribute to glenohumeral instability, and both biomechanical and clinical studies have shown improvements in anterior shoulder stabilization following RI closure. The benefits of RI repair in the setting of posterior shoulder and multidirectional instability, however, are unclear. The optimal surgical technique is also unclear, and a variety of open and arthroscopic methods have been described. The purposes of this article are to review the surgical anatomy relevant to RI closure, discuss the biomechanical rationale for repairing the RI, and provide our preferred technique for performing arthroscopic RI closure.