Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale

Ten patients with painful, massive (greater than 5 cm), complete rotator cuff tears involving primarily the supraspinatus were treated with arthroscopic acromioplasty and rotator cuff debridement. All patients except one had normal active motion and strength preoperatively. All patients had roentgenographically normal acromiohumeral distance and an anterior-inferior acromial osteophyte. The goal was to obtain pain relief without loss of motion of strength. This was accomplished in all patients. This study shows that normal shoulder function is possible with a massive unrepaired tear of the rotator cuff. Normal function in the face of an unrepaired cuff tear can occur only if there is a balance of two important force couples, one in the coronal plane and the other in the transverse plane. This balance depends upon the functional integrity of the anterior cuff, the posterior cuff, and the deltoid. In patients whose cuff tears satisfy these anatomic and biomechanical criteria, the achievement of pain relief through arthroscopic debridement and decompression seems to be all that is necessary for normal pain-free function.