Irreparable cuff tears: an update on treatment options

Abstract

The management of irreparable cuff tears can be challenging. Decision-making can be difficult, especially in the young patient, where every effort should be made to preserve the native joint surface and its function. There are a number of options available to the shoulder surgeon, including non-operative and operative. Non-operative options include analgesics, intra-articular steroid injections and physiotherapist-guided rehabilitation. Minimally invasive interventions include arthroscopic debridement, biceps tenotomy, subacromial decompression and suprascapular nerve ablation. Surgical options include partial rotator cuff repair, bridging grafts and superior capsular reconstruction. In the younger patient, various tendon transfer options are available to reduce pain and improve range of motion. In the presence of arthrosis, reverse geometry shoulder arthroplasty offers long-term pain relief and good functional outcome. The surgeon should be aware of the possible treatment options when deciding on management and should tailor the management to the individual's needs and expectations. This article aims to summarize the current practice and literature surrounding this topic.