Treatment options in full thickness rotator cuff tears

Increasing interest in shoulder pathology during the last decades has considerably diversified the possible treatment options of full thickness rotator cuff tears. This review of the recent literature combined with information gathered during recent European shoulder meetings attempts to summarize present trends. Every full thickness cuff tear, except for the acute traumatic tear in younger patients, should always benefit first from a conservative rehabilitation program. In case of failure of the latter, reparable tears should be repaired, except perhaps in a low-demand population. This latter group of patients, presenting with a massive, irreparable tear may be satisfied with an arthroscopic debridement, but interposition techniques provide better results in activities of daily living and also give better strength. Salvage procedures such as muscle tendon transfers are technically demanding and must be reserved for the younger age group. For arthroplasty, the choice between a nonconstrained total prosthesis and a hemiprosthesis can be difficult; the early functional results of the reversed prosthesis seem to be very promising in an elderly but still active population.