Treatment of large and massive rotator cuff tear must be based on individual patient indications: Bridging Repair Allows Low Tension Repair of Irreparable Tears.

Treatment options for large and massive rotator cuff tears, in the setting of failed conservative treatment, include debridement, isolated biceps tenotomy or tenodesis, primary repair, partial repair, subacromial spacer, superior capsular reconstruction, biologic tuberoplasty, bridging reconstruction, tendon transfers, reverse shoulder arthroplasty, and others. Each performs well under optimal indications. Bridging reconstruction performs best in the setting of an irreparable tear of the superior-posterior rotator cuff, with an intact or reparable subscapularis, particularly if the patient has reasonably preserved function/range of motion preoperatively. Advantages of bridging reconstruction include lower-tension repair, which may be superior to partial primary repair with incomplete footprint coverage in the case of irreparable tears.