Massive Tears of the Rotator Cuff

Even though it may seem simple to classify rotator cuff tears only by size, clinical studies tend to confirm that treatment outcomes are directly related to it. Tear size was identified as the single most important factor determining final active motion, strength, satisfaction and need for revision in a series of 105 patients who underwent open rotator cuff repair [11]. When comparing repairs performed in groups of large and massive tears with groups including small and medium sized ones there is a definite tendency to poorer outcomes in those with the bigger defects independent of the surgical technique used [22]. In this unfavourable scenario treatment protocols should be well-established. The surgeon finds himself facing a wide range of options with confusing data supporting each one. There are reports of successful non-operative management; debridement and decompression has been shown to help others; structurally-failed repairs are not unheard of with good clinical outcomes; and partial repairs can restore function [4, 27]. It is only by reviewing pertinent information and matching it with personal experience that the surgeon can make appropriate treatment decisions.