Clin Orthop Surg.  2018 Jun;10(2):119-134. 10.4055/cios.2018.10.2.119.

Treatment Strategy for Irreparable Rotator Cuff Tears

• Oh JH
• Park MS
• Rhee SM

• KMID: 2411736
• DOI: http://doi.org/10.4055/cios.2018.10.2.119

Abstract

Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.

Keyword

Rotator cuff tear; Massive rotator cuff tear; Irreparable rotator cuff tear

MeSH Terms

Adult
Humans
Muscular Atrophy
Rotator Cuff*
Shoulder
Shoulder Pain
Tears*

Figure

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  Fig. 1 Anterior deltoid rehabilitation.

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  Fig. 2 Arthroscopic view of a right shoulder through a posterior portal using a 70° arthroscope. The coracohumeral ligament was released from the posterolateral arch of the coracoid process (arrow). CN: coracoid neck, CT: coracoid tip, SSc: subscapularis tendon.

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  Fig. 3 (A) Arthroscopic image of a right shoulder with a massive rotator cuff tear. (B) Arthroscopic image obtained after rotator cuff repair and margin convergence (arrows).

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  Fig. 4 (A) Arthroscopic image showing a massive rotator cuff tear. Repair was impossible because the rotator cuff was unable to be mobilized. (B) After allogenic dermal patch graft insertion, single-row repair was performed. The medial border of the graft (arrow) was sutured to the rotator cuff and a suture anchor was inserted at the lateral border of the graft.

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  Fig. 5 (A) Arthroscopic image of a right shoulder with a massive rotator cuff tear. (B) Arthroscopic image obtained after rotator cuff repair and biceps augmentation (arrow).

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  Fig. 6 (A) Arthroscopic image showing a massive rotator cuff tear. Superior capsular reconstruction involves acromioplasty for prevention of graft abrasion and preparation of superior aspect of the glenoid tubercle (arrows). (B) After allogenic graft insertion, the graft is attached medial to the superior aspect of the glenoid tubercle (arrows) and lateral to the greater tuberosity using one suture anchor. Then, the graft is sutured to the infraspinatus posteriorly and the subscapularis anteriorly to restore force coupling of the joint.

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  Fig. 7 Arthroscopic images of a right shoulder with a massive rotator cuff tear. The rotator cuff was unable to be mobilized; thus, following subacromial decompression (A), partial repair (black arrow) (B) and biodegradable subacromial spacer (white arrow; InSpace System, Orthospace, Caesarea, Israel) insertion (C) were performed.

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