A historical review: Surgical management of massive irreparable rotator cuff tears

Massive irreparable rotator cuff tears (MIRCTs) represent a complex clinical challenge, resulting in pain, pseudoparalysis, and functional disability. Over the past century, their surgical management has undergone significant evolution, from early open repairs to sophisticated reconstructive and joint replacement strategies.

A historical narrative review was conducted, informed by a systematic search of PubMed/MEDLINE, Embase, and landmark texts. Major surgical innovations-open repair, tendon transfers, debridement, superior capsular reconstruction (SCR), subacromial spacers, and reverse shoulder arthroplasty (RSA)-were examined in the context of their development and impact.

Open repairs offered limited success for chronic MIRCTs. Subacromial decompression and debridement provided symptom relief in low-demand patients. Tendon transfers and graft interpositions emerged as joint-preserving strategies in select cases. RSA transformed management by reliably restoring function in pseudoparalysis and cuff tear arthropathy. Contemporary techniques such as SCR and biologic augmentation aim to preserve native anatomy, but outcomes remain inconsistent.

MIRCT management has progressed from salvage repairs to a diverse toolkit of joint-preserving and reconstructive options. No single strategy is universally superior, underscoring the need for patient-specific approaches. Ongoing comparative trials and surgical consensus efforts are critical to optimising care.