[Irreparable rotator cuff tears]

Irreparable rotator cuff tears show increasing incidence with age. In symptomatic cases, first-line therapy should be a minimum of six months of physical training, as many improve over time. Reparability is evaluated clinically and by MRI - assessing tendon retraction, fatty infiltration, and muscle atrophy. If symptoms persist, surgical treatment is considered: reverse shoulder arthroplasty is generally offered to older patients (> 60 years), while joint-preserving procedures such as tendon transfer or superior capsular reconstruction may be suitable for younger patients (less-than 60 years), as argued in this review.