Editorial Commentary: Rotator Interval Closure of the Shoulder Continues to Be a Challenge in Consensus on Treatment.

In discussions of repair or plication of rotator interval capsular tissue and the respective surgical techniques, there is great variability in the procedures used to accomplish this, as well as a lack of consensus in defining rotator interval closure and the complex associated anatomy. The concept of rotator interval closure and how it is performed has shown wide variation and numerous definitions. In the future, it is recommended that one truly define what type of closure is performed, what tissues are imbricated, and where these tissues are imbricated, because both medial and lateral imbrications around the joint can have significant differences in terms of rotation, stability, and overall efficacy. Through this work, we can improve diagnostic capabilities, as well as examination capabilities, and better delineate the overall rotator interval closure procedure based on diagnostic and clinical findings. In this manner, we will be better able to define when rotator interval closure is necessary and most beneficial to patients. In our opinion, clinical indications for rotator interval closure are as follows: (1) multidirectional instability with increased capsular volume, (2) anterior instability-and especially a failed arthroscopic instability repair-that could benefit from imbrication of the coracohumeral ligament, (3) a sulcus that persists in external rotation in the setting of symptomatic instability, and (4) posterior instability with a multidirectional component.