Surgical Management of Irreparable Rotator Cuff Tears: What Works, What Does Not, and What Is Coming.

Abstract

➤ The term functionally irreparable rotator cuff tear (FIRCT) is intended to capture patients who would experience failure of an attempted primary rotator cuff repair because of the extent of cuff muscle and tendon damage and other patient-related factors.➤ Debridement, biceps tenodesis, and/or partial repair of the torn rotator cuff may reduce pain and improve function for selected patients with a FIRCT.➤ Static soft-tissue restraints to abnormal glenohumeral head translation, such as implantation of an absorbable balloon in the subacromial space or superior capsular reconstruction (SCR), appear to reduce pain and improve function, although some have reported a relatively high structural failure rate with SCR.➤ When improvement of strength is the primary goal of treatment, tendon transfers provide a viable treatment alternative; most tendon transfers for management of a FIRCT are currently performed with arthroscopically assisted techniques.➤ Transfer of the lower portion of the trapezius has emerged as a successful alternative to transfer of the latissimus dorsi, whereas transfer of the latissimus dorsi to the lesser tuberosity is being explored as an alternative to transfer of the pectoralis major for functionally irreparable subscapularis tears.