[How to treat massive rotator cuff tears].

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Reconstruction

Background:

• Massive rotator cuff tears present complex treatment challenges.
• Optimal surgical outcomes depend on tailoring treatment to individual patient factors.

Purpose of the Study:

• To outline a decision-making algorithm for managing massive rotator cuff tears.
• To present various surgical techniques based on tear characteristics and patient profiles.

Main Methods:

• Evaluation of direct transosseous repair feasibility.
• Consideration of margin convergence, biceps tendoplasty, and local tendon transfers for insufficient tissue.
• Assessment of muscle and tendon transfers (deltoid, latissimus dorsi, pectoralis) for unreconstructable defects.
• Indications for arthroplasty (tubercleplasty/subacromial decompression or reverse prosthesis) in specific patient groups.

Main Results:

• Direct repair is attempted first; if not feasible, alternative techniques are employed.
• Margin convergence or biceps tendoplasty can address partial closure needs.
• Muscle transfers are indicated for significant defects, with specific transfers for balanced vs. unbalanced tears.
• Reverse prosthesis serves as a salvage option for elderly patients with osteoarthritis and superior humeral migration.

Conclusions:

• A stepwise, individualized approach is crucial for managing massive rotator cuff tears.
• Surgical strategy selection must consider tissue quality, tear size, patient age, and functional demands.
• Advanced reconstructive techniques and prosthetic options offer solutions for complex cases.