Arthroscopic repair of Massive rotator cuff tears

April 27th, 2007

Massive tears are defined as greater than 5 cm, but for all intents and purposes, these are tears that involve the entire insertion of the supraspinatus and infraspinatus tendons, with some involement of the teres minor--or complete slippage off the back of the humeral head of the former two tendons. A "bald" humeral head is noted, and xray may show superior migration. Typically you will be unable to raise your arm above 90 degrees and will not be capable of generating any external rotation strength.

Arthroscopic assessment may reveal that repair is not possible, however, there exists growing clinical evidence that muscle denervation may be reversible after repair of chronic tears because of a beneficial effect on the suprascapular nerve.

Repair of massive tears may require anterior and posterior "interval slides." In some cases, only a partial repair is possible. In my experience with 16 massive repairs over the past 3 years, I have come to believe that there is no role for saying: "I am sorry--you have an irreparable tear." In fact, surgical techniques may allow for at least a partial repair, which truly can improve function.

Postoperative rehabilitation begins after 6 weeks of strict immobilization in a sling. passive motion takes place from 6 until 12 weeks. Active motion starts at 3 months, and full recovery may take 12-18 months.

Related Photos:

Preoperative MRI image shows a retracted tear

Bald humeral head, and massive tear identified

Repaired massive cuff tear

Postoperative forward flexion at 6 months

Postoperative external rotation at 6 months

Related Videos:

Subacromial assessment of massive tear

Traction suture shows the mobilization and reparability of the massive tear

Completed repair

Outcome following massive repair