TY  - JOUR
T1  - Massive Rotator Cuff Tears without ArthropathyWhen to Consider Reverse Shoulder Arthroplasty
AU  - Harreld, Kevin L.
AU  - Puskas, Brian L.
AU  - Frankle, Mark
Y1  - 2011/05/18
N1  - 
JO  - The Journal of Bone & Joint Surgery
SP  - 973
EP  - 984
VL  - 93
IS  - 10
N2  - 
Patients with large, retracted rotator cuff tears present a surgical challenge to relieve pain and restore shoulder function. However, the term massive rotator cuff tear has only recently been adopted. The first studies to employ this description were published in the late 1970s and early 1980s, focusing on techniques and outcomes associated with freeze-dried rotator cuff allografts or muscle transfers1,2. Since then, massive rotator cuff tears have been increasingly recognized, and are now a topic of particular emphasis in clinical and biomechanical research. A PubMed search yields almost 350 articles on this topic, with nearly 200 studies published within the last five years. Despite this increased focus, an optimal treatment has yet to be established. Current studies outline a variety of techniques to address such tears, including debridement with acromioplasty3,4, biceps tenotomy5, tenotomy with tuberoplasty6, partial repair7,8, complete arthroscopic repair9,10, mini-open repair11,12, tissue augmentation13,14, tendon transfer15,16, deltoid flap17,18, hemiarthroplasty19,20, and reverse shoulder arthroplasty21,22. The definition of massive rotator cuff tear has been inconsistent. Commonly accepted definitions include a tear size >5 cm3,23, a complete tear of at least two tendons24,25, or both26. However, the more important distinction, rather than tear size or number of tendons involved, is the healing potential of the tendon and the ability to technically achieve a satisfactory repair. A massive rotator cuff tear is not necessarily an irreparable tear27. Determining healing potential is critical to selecting the appropriate surgical strategy, as a subset of rotator cuff tears remains irreparable28. Many acute tears may be quite large and may involve two or more tendons, but they may still be mobile and repairable. Conversely, smaller tears may prove to be irreparable and may represent a separate clinical entity.

SN  - 0021-9355
M3  - doi: 
UR  - http://dx.doi.org/
ER  -