Massive Rotator Cuff Tears: Tips and Tricks for Surgical Management

Massive rotator cuff tears provide a significant challenge to the orthopedic surgeon. A complete and anatomical tendon restoration without significant tension is the goal of treatment, but oftentimes the chronicity of the presentation makes it difficult. The treating surgeon must approach these cases in a methodical and organized manner. Visualization and recognition of the tear pattern, followed by appropriate soft tissue releases, and finally thoughtful suture management are the keys to optimizing surgical success and ultimately clinical outcomes. When the tendon cannot be anatomically restored to the native footprint, alternative options can be used with varying success. These alternatives include medialization of the footprint, partial repair, margin convergence, and patch augmentation, among others. We will provide some tips and tricks which we have found most useful to successfully complete these often-difficult cases. For tears that cannot be repaired or if a repair would be contraindicated or ill-advised, other options such as superior capsular reconstruction, tendon transfers, and reverse total shoulder arthroplasty are considerations that are beyond the scope of this manuscript.