Editorial Commentary: Repair or Reconstruct Large Rotator Cuff Defects? Still in Search for the Answer

Large and massive rotator cuff tears remain a significant challenge in orthopaedic surgery. Although numerous surgical techniques have been described, no single approach has emerged as the definitive treatment for this complex pathology. Although many patients remain asymptomatic and report satisfactory clinical outcomes, structural failure remains common, with retear rates on postoperative magnetic resonance imaging approaching 50% at 10-year follow-up in some series. Overall, conventional rotator cuff repair remains an effective treatment strategy, showing clinical outcomes comparable to augmented repairs. Many studies have shown the biological benefits of patches and the safety of these scaffolds. Ideally, a large multicenter randomized controlled trial would answer whether routine patch augmentation is necessary and beneficial in the management of large and massive rotator cuff tears.