Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options

Abstract

• While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function. • Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure. • In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used. • However, several innovative arthroscopic treatment options have also been developed. • The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results. • Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers