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Review
. 2018 Dec 5:10:93-103.
doi: 10.2147/ORR.S151259. eCollection 2018.

Irreparable rotator cuff tears: challenges and solutions

Michele Novi  1 , Avinash Kumar  2 , Paolo Paladini  3 , Giuseppe Porcellini  4 , Giovanni Merolla  3   5
Affiliations
Review

Irreparable rotator cuff tears: challenges and solutions

Michele Novi et al. Orthop Res Rev. .

Abstract

Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.

Keywords: arthroscopy; graft augmentation; irreparable rotator cuff tear; partial repair; tendon transfer.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Subacromial biodegradable spacer implantation. (A) Probe used to choose the size of the spacer. (B) Subacromial spacer inflated with saline solution at the end of the arthroscopic procedure.
Figure 2
Figure 2
Arthroscopic partial repair of the posterior bundle of the rotator cuff (infraspinatus tendon) with a triple suture anchor.
Figure 3
Figure 3
Arthroscopically assisted latissimus dorsi (LD) transfer. (A) LD detached from the humerus insertion using an axillary incision; (B) arthroscopic partial “functional” repair of the posterior cuff (infraspinatus); and (C, D) LD tendon fixation.
Figure 4
Figure 4
Pectoralis major (PMa) tendon transfer. (A) PMa tendon detachment from the humerus insertion and muscle belly release. (B) Fixation on the lesser tuberosity of the humerus.
Figure 5
Figure 5
Pectoralis minor (PMi) tendon transfer. (A) PMi tendon detachment from the coracoid insertion. (B) Fixation in the upper part of the subscapularis footprint of the humerus (under the conjoined tendon).
Figure 6
Figure 6
Intraoperative findings of arthroscopic massive rotator cuff repair with dermal allograft augmentation (interposition allograft).
Figure 7
Figure 7
Schematic diagram describing therapeutic options for irreparable rotator cuff tears (RCTs).
See this image and copyright information in PMC

References

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