From the Guidelines
Surgical options for massive irreparable rotator cuff tears include reverse shoulder arthroplasty, which can improve reported outcomes in patients with pseudoparalysis who have failed other treatments. The choice of surgical option depends on various patient factors, including age, activity level, and functional goals 1.
Surgical Options
- Debridement with biceps tenotomy/tenodesis: provides pain relief but minimal functional improvement, best for elderly, low-demand patients
- Partial repair: aims to restore force couples and improve biomechanics even when complete closure is impossible 1
- Superior capsular reconstruction: uses dermal allograft to stabilize the humeral head and has shown good mid-term outcomes for younger patients
- Tendon transfers: can restore function by substituting intact muscles for torn rotator cuff tendons
- Subacromial spacer implantation: provides temporary humeral head depression to improve biomechanics
- Reverse shoulder arthroplasty: remains the most reliable option for older patients with pseudoparalysis and arthritis, as it changes shoulder biomechanics to rely on the deltoid rather than the rotator cuff 1
Key Considerations
- Patient age and activity level play a significant role in determining the optimal surgical option
- Functional goals and expectations should be carefully considered when selecting a surgical approach
- Early physical therapy is essential after any procedure to optimize outcomes and prevent stiffness
- The most recent evidence suggests that reverse shoulder arthroplasty can improve reported outcomes in patients with massive, unrepairable rotator cuff tears and pseudoparalysis who have failed other treatments 1
From the Research
Surgical Options for Massive Irreparable Rotator Cuff Tears
The following are surgical options for massive irreparable rotator cuff tears:
- Partial repair with or without graft augmentation 2
- Interposition grafts 2, 3
- Superior capsule reconstruction (SCR) 2, 3
- Subacromial balloon spacers 2, 3
- Tendon transfer, including trapezius and latissimus dorsi transfer 4, 2, 3, 5
- Reverse total shoulder arthroplasty (RTSA) 2, 3, 6
Considerations for Surgical Indications
Surgical indications are based on factors such as patient age, functional demands, and presence of glenohumeral osteoarthritis 2.
- For younger patients without glenohumeral osteoarthritis, tendon transfers may be a promising option 4, 2, 5
- For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option 2, 6
Clinical Outcomes
Clinical outcomes for these surgical options have been reported in various studies, with some procedures showing promising short-term results 2, 3.
- Partial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates 2
- SCR appears to produce excellent short-term results, particularly when performed at high volume 2
- Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients 4, 2, 5