Management of the Irreparable Rotator Cuff Tear

Gregory L. Cvetanovich, MD; Brian R. Waterman, MD; Nikhil N. Verma, MD; Anthony A. Romeo, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(24):909-917. 

In This Article

Summary

Patients with irreparable rotator cuff tears present diagnostic and treatment challenges for orthopaedic surgeons. Careful physical examination and imaging evaluation with radiographs and MRI can help to delineate patients with pseudoparalysis and predict those with reparable versus irreparable tears. In older patients with rotator cuff arthropathy and relatively sedentary demands, the RSA has been established as the preferred treatment option, producing reliable improvements in pain and function. In younger patients without significant arthritis, joint-preserving options are preferred, with an increasing array of treatment options including partial repair, bridging interpositional graft placement, tendon transfers (ie, latissimus, trapezius, and pectoralis major), SCR, and subacromial spacer. We present our preferred treatment algorithm for these patients, which currently includes RSA for Hamada grade 3 and above rotator cuff arthropathy and patients older than 65 years. Because of our experience of more reliable pain relief and functional improvement, SCR has become our preferred approach for patients younger than 65 years with irreparable rotator cuff tear and no rotator cuff arthropathy (Hamada grades 1 and 2). Existing literature has little in the way of comparative studies of the various treatment options for irreparable rotator cuff tear, and future studies will be needed to define the indications and contraindications for the available techniques in a range of patients.

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