Treatment of Massive Rotator Cuff Tears: Focusing on Arthroscopic Approach

Seung Won Lee; Min Soo Shon; Jae Chul Yoo

doi:10.4055/jkoa.2013.48.1.61

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Lee, Shon, and Yoo: Treatment of Massive Rotator Cuff Tears: Focusing on Arthroscopic Approach

Instructional Course Lecture

Management of Massive Rotator Cuff Tear

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(1): 61-69.

Published online: 26 February 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.1.61

Treatment of Massive Rotator Cuff Tears: Focusing on Arthroscopic Approach

Seung Won Lee, M.D., Min Soo Shon, M.D.^*, Jae Chul Yoo, M.D.

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, National Medical Center, Seoul, Korea.

Correspondence to: Jae Chul Yoo, M.D. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. TEL: +82-2-3410-3501, FAX: +82-2-3410-0061, shoulderyoo@gmail.com

Received 31 January 2013 Revised 13 February 2013 Accepted 14 February 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There are no standard guidelines for treatment of massive rotator cuff tears. In this article, we reviewed the various modalities for treatment of massive rotator cuff tears, especially focusing on arthroscopic treatment. Selection of one of a variety of treatment modalities is essential for understanding pathogenesis, biomechanics and reparability of massive rotator cuff tears. The best clinical results have been reported with arthroscopic complete repair of massive rotator cuff tear. Satisfactory results have also been reported with other various arthroscopic treatment methods, including simple debridement, partial repair, biceps tenotomy or tendesis, and augmentation using a tissue substitution. However few long-term follow up results are available with these salvage options. Treatment of massive rotator cuff tears is difficult due to high incidence of irreparable tears and re-tear rate. Thus, understanding the advantages and disadvantages of various treatment modalities is thought to be helpful to improving the outcome of treatment of massive rotator cuff tears.

Keywords: rotator cuff, massive tear, arthroscopy

Figures and Tables

Figure 1

(A) Pre-operative magnetic resonance imaging shows a massive rotator cuff tear with severe tendon retraction and (B) fatty degeneration. (C) Arthroscopic finding of the same patient shows severe retraction of tendons. (D) Rotator cuff tendons could not be restored to the original footprint, despite of mobilization; therefore partial repair was performed. H, humeral head; G, Glenoid; SS, supraspinatus; SC, subscapularis; IS, infraspinatus; TM, teres minor.

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