Algorithm of indications in symptomatic irreparable cuff tear

Abstract

Irreparable rotator cuff tear are rare and may present with a variety of clinical manifestations and distinct anatomic patterns. A rotator cuff tear is defined as irreparable if the quality of the tendon is so poor that direct tendon to bone repair is not possible and/or the muscle is atrophic or infiltrated stage III or IV regarding Goutallier classification. There are two distinct anatomic patterns: the posterosuperior tear involves the supraspinatus (SS) and the infraspinatus (IS) and the less common anterosuperior tear involves the subscapularis and the supraspinatus. The posterosuperior tear can be extended to the teres minor with a lack of active external rotation and a positive drop sign or hornblower sign.Very infrequently the posterosuperior tear can be extended anteriorly to the subscapularis defined as a “global” irreparable rotator cuff tear.