Irreparable rotator cuff tears: challenges and solutions

Michele Novi,¹ Avinash Kumar,² Paolo Paladini,³ Giuseppe Porcellini,⁴ Giovanni Merolla<sup>3,5

1</sup>Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy; ²Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India; ³Shoulder and Elbow Unit, “D. Cervesi” Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy; ⁴Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; ⁵“Marco Simoncelli” Biomechanics Laboratory, “D. Cervesi” Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy

Abstract: Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.

Keywords: irreparable rotator cuff tear, arthroscopy, partial repair, tendon transfer, graft augmentation