Isakos Scoring System for Rotator Cuff Tears

A classification for rotator cuff tears should follow several principles. First, the classification system should be already in use, if possible, validated for reliability, and easily used by physicians and researchers. Second, it should be descriptive to define the location and anatomy of the tear, helping all surgeons to understand precisely its characteristics. Third, the classification should be useful to dictate appropriate treatment in each specific case, and fourth, it should also have a predictive value both to guide physicians and to transmit the patient realistic expectations of postoperative outcome. The ISAKOS Shoulder Terminology Group developed a new complete and straightforward method to describe rotator cuff tears. It relies on the fact that a good system should allow the surgeon to predict difficulties during the procedure and advise about prognostics. It is comprehensive and userfriendly. This system encompasses five essentials characteristics with regards to tears: pattern (P), extension (E), fatty atrophy (A), retraction(R), and location (L), conforming the acronym “PEARL” (Table 1).