Surgical Options for Massive Rotator Cuff Tears with Preserved Full Range of Motion in Middle-Aged Patients

Rotator cuff tears (RCTs) are a primary cause of shoulder pain and dysfunction. The progression of these tears, coupled with the intricate biomechanics of the shoulder joint, makes the repair and management of massive rotator cuff tears (MRCTs) particularly challenging for surgeons. For younger patients who are ineligible for arthroplasty, surgical approaches for MRCTs-such as biologic augmentation, interpositional grafts, and techniques like superior capsular reconstruction and biceps rerouting to counteract humeral upward migration-are gaining prominence. Additionally, tendon transfers, supraspinatus advancement, and subacromial balloon spacers are increasingly being utilized to manage MRCTs. This review aims to provide a concise overview and analysis of current research on the evaluation and arthroscopic management of MRCTs in middle-aged patients to aid in shaping and refining future treatment approaches.