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Updated: Feb 16, 2026
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Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
710
Preoperative Radiographic Risk Factors for Incomplete Arthroscopic Supraspinatus Tendon Repair in Massive Rotator
Andrew J Sheean1, Robert U Hartzler2, Patrick J Denard3
1San Antonio Military Medical Center, San Antonio, Texas, U.S.A.; San Antonio Orthopaedic Group, Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A..
Summary
Preoperative imaging signs like the tangent sign and Goutallier grade indicate risk for incomplete rotator cuff (RC) repair. However, most massive RC tears remain repairable despite these indicators.
Area of Science:
- Orthopedic Surgery
- Musculoskeletal Imaging
- Sports Medicine
Background:
- Massive rotator cuff (RC) tears present a surgical challenge.
- Preoperative imaging is crucial for surgical planning in RC repair.
- Identifying factors predicting repairability is essential for patient outcomes.
Purpose of the Study:
- To assess if preoperative imaging findings predict incomplete arthroscopic repair of massive rotator cuff tears.
- To determine if imaging characteristics correlate with the use of advanced arthroscopic techniques.
Main Methods:
- Retrospective evaluation of 86 patients with massive RC tears undergoing arthroscopic repair.
- Analysis of radiographic risk factors: acromiohumeral distances, tangent sign, and Goutallier stage of fatty infiltration.
- Statistical analysis using binary logistic regressions and Fisher's exact tests.
Main Results:
- 88% of massive RC tears were fully reparable.
- A positive tangent sign and Goutallier grade 3-4 fatty infiltration were associated with incomplete repair (OR=6.3 and OR=11.8, respectively).
- Advanced arthroscopic techniques were used in 62% of cases, with no correlation to preoperative imaging findings.
Conclusions:
- Positive tangent sign and high-grade fatty infiltration are risk factors for incomplete rotator cuff repair.
- These imaging findings are not fully predictive, as most massive tears remain repairable.
- Further research may refine predictive models for massive rotator cuff tear reparability.
