Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

Abstract

Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.

Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

“…These include nonoperative management with structured physical therapy, partial RCR, isolated debridement and acromioplasty, long head of the biceps tenotomy, superior capsular reconstruction, graft interposition, balloon spacer arthroplasty, tendon transfers, and RTSA. 3,32,39 A full systematic review of all treatment options is beyond the scope of this article, but we believe that this systematic review helps inform the clinician that RCR in this age group can be successful for the appropriately selected patient.…”

A Lasso-Loop Traction Technique for Arthroscopic Superior Capsular Reconstruction

“…Partial repair was first described by Burkhart et al, 8 and several studies found a statistically significant improvement in functional outcome scores versus preoperatively. 9 However, Burkhart and Hartzler 10 found that pseudoparalysis can be more reliably reversed after superior capsular reconstruction (90%) than with partial repair (44%).…”

Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods

“…Tendon transfer is a good option for irreparable failed rotator cuff repair patients. Muscles commonly used for tendon transfer include latissimus dorsi (LD), pectoralis major (PM), and lower trapezius (LT) [73,74]. Since the LD transfer is intended to restore the posterior force-couple of the shoulder, LD transfer requires consideration in rupture of the rotator cuff, including posterior part of supraspinatus and infraspinatus and teres minor.…”