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Abstract

Irreparable rotator cuff tears are a challenging problem facing orthopedic surgeons. Multiple treatment strategies have been proposed depending on patient factors such as age, activity, and the quality of the rotator cuff tendon. The clinical presentation of a patient with an irreparable rotator cuff tear is variable with respect to pain, function, and disability, necessitating a thorough, detailoriented clinical evaluation. Initial imaging should include plain radiographs and magnetic resonance imaging (MRI) to evaluate tendon quality. Computed tomography (CT) arthrography may be used if MRI is contraindicated. Non operative treatment is generally reserved for low demand patients with minimal pain, while debridement, partial-repair, and subacromial decompression with or without biceps tenodesis versus tenotomy have been advocated in low demand patients with significant pain. However, these treatment modalities often result in unpredictable and marginal improvements in functional outcomes. Tendon transfers including the latissimus dorsi, pectoralis major, and trapezius muscles have been used to improve function. Scaffold devices have more recently been used as a biologic patch graft and augment. Superior capsule reconstruction is a novel technique that has been shown to restore glenohumeral stability. Reverse total shoulder arthroplasty and hemiarthroplasty can be used as salvage options in patients with rotator cuff tear arthropathy. Keywords: