Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

Abstract

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients.

Keywords: Irreparable; Arthroscopy; Rotator cuff; Repair; Massive

Core tip: This paper reviews the current literature and available techniques to arthroscopically address irreparable rotate cuff tears. It includes all historic and recent innovative methods to address this difficult and challenging clinical problem. Readers of this article will be in a position to make an informed decision as to the most appropriate treatment for their patients based on the most up to date literature.