Skip to main content
SpringerLink
Log in

Massive Rotator Cuff Lesion: Arthroscopic Repair

  • Chapter
  • First Online:
Latissimus Dorsi Transfer

  • 413 Accesses

Abstract

The treatment of massive rotator cuff tears is challenging, and a number of different surgical tactics have been proposed. Advancements in shoulder arthroscopy allow for enhanced visualization of rotator cuff tear morphology and a thorough assessment of tissue quality and mobility. A number of arthroscopic techniques have been described to visualize relevant pathology, mobilize contracted or less compliant tissues, and promote durable, tension-free repairs. In cases of truly irreparable rotator cuff tears, superior capsular reconstruction has emerged as a viable alternative to open tendon transfers and arthroplasty procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Burkhart SS, Barth JR, Richards DP, Zlatkin MB, Larsen M. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy. 2007;23(4):347–54.

    Article  PubMed  Google Scholar 

  2. Denard PJ, Ladermann A, Jiwani AZ, Burkhart SS. Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis. Arthroscopy. 2012;28(9):1214–9.

    Article  PubMed  Google Scholar 

  3. JH O, Kim SH, Shin SH, Chung SW, Kim JY, Kim SH, et al. Outcome of rotator cuff repair in large-to-massive tear with pseudoparalysis: a comparative study with propensity score matching. Am J Sports Med. 2011;39(7):1413–20.

    Article  Google Scholar 

  4. Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am. 2008;90(6):1244–51.

    Article  PubMed  Google Scholar 

  5. Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elb Surg. 2009;18(4):600–6.

    Article  Google Scholar 

  6. Elhassan B, Endres NK, Higgins LD, Warner JJ. Massive irreparable tendon tears of the rotator cuff: salvage options. Instr Course Lect. 2008;57:153–66.

    PubMed  Google Scholar 

  7. Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am. 2010;92(15):2544–56.

    Article  PubMed  Google Scholar 

  8. Boileau P, WB MC Jr, Rumian AP. Massive irreparable rotator cuff tears: how to rebalance the cuff-deficient shoulder. Instr Course Lect. 2014;63:71–83.

    PubMed  Google Scholar 

  9. Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elb Surg. 2011;20(2 Suppl):S20–9.

    Article  Google Scholar 

  10. Harreld KL, Puskas BL, Frankle MA. Massive rotator cuff tears without arthropathy: when to consider reverse shoulder arthroplasty. Instr Course Lect. 2012;61:143–56.

    PubMed  Google Scholar 

  11. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy. 1994;10(4):363–70.

    Article  CAS  PubMed  Google Scholar 

  12. Weber S. Arthroscopic partial rotator cuff repair in the management of massive rotator cuff tears: long-term follow-up. Arthroscopy. 2011;32(6):e3.

    Article  Google Scholar 

  13. Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC, et al. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40(1):141–7.

    Article  PubMed  Google Scholar 

  14. Adams CR, Denard PJ, Brady PC, Hartzler RU, Burkhart SS. the arthroscopic superior capsular reconstruction. Am J Orthop (Belle Mead NJ). 2016;45(5):320–4.

    Google Scholar 

  15. Petri M, Greenspoon JA, Millett PJ. Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthrosc Tech. 2015;4(6):e751–5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40(10):2248–55.

    Article  PubMed  Google Scholar 

  17. Warner JJ. Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect. 2001;50:63–71.

    CAS  PubMed  Google Scholar 

  18. Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elb Surg. 2014;23(7):1023–7.

    Article  Google Scholar 

  19. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86-a(2):219–24.

    Article  PubMed  Google Scholar 

  20. Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82(3):304–14.

    Article  CAS  PubMed  Google Scholar 

  21. Liu SH, Baker CL. Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10(1):54–60.

    Article  CAS  PubMed  Google Scholar 

  22. Kim HM, Caldwell JM, Buza JA, Fink LA, Ahmad CS, Bigliani LU, et al. Factors affecting satisfaction and shoulder function in patients with a recurrent rotator cuff tear. J Bone Joint Surg Am. 2014;96(2):106–12.

    Article  PubMed  Google Scholar 

  23. Slabaugh MA, Nho SJ, Grumet RC, Wilson JB, Seroyer ST, Frank RM, et al. Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair? Arthroscopy. 2010;26(3):393–403.

    Article  PubMed  Google Scholar 

  24. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–40.

    PubMed  Google Scholar 

  25. Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elb Surg. 2009;18(1):13–20.

    Article  Google Scholar 

  26. Sheean AJ, Hartzler RU, Denard PJ, Ladermann A, Hanypsiak BT, Burkhart SS. A 70 degrees arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position. Arthroscopy. 2016;32(9):1745–9.

    Article  PubMed  Google Scholar 

  27. Brady PC, Narbona P, Adams CR, Huberty D, Parten P, Hartzler RU, et al. Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate. Arthroscopy. 2015;31(3):470–6.

    Article  PubMed  Google Scholar 

  28. Lo IK, Burkhart SS. The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy. 2003;19(3):334–7.

    Article  PubMed  Google Scholar 

  29. Denard PJ, Burkhart SS. Medialization of the subscapularis footprint does not affect functional outcome of arthroscopic repair. Arthroscopy. 2012;28(11):1608–14.

    Article  PubMed  Google Scholar 

  30. Denard PJ, Lädermann A, Burkhart SS. Arthroscopic management of subscapularis tears. Sports Med Arthrosc. 2011;19(4):333–41.

    Article  PubMed  Google Scholar 

  31. Denard PJ, Burkhart SS. A new method for knotless fixation of an upper subscapularis tear. Arthroscopy. 2011;27(6):861–6.

    Article  PubMed  Google Scholar 

  32. Davidson J, Burkhart SS. The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy. 2010;26(3):417–24.

    Article  PubMed  Google Scholar 

  33. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy. 2004;20(1):22–33.

    Article  PubMed  Google Scholar 

  34. Lo IK, Burkhart SS. The interval slide in continuity: a method of mobilizing the anterosuperior rotator cuff without disrupting the tear margins. Arthroscopy. 2004;20(4):435–41.

    Article  PubMed  Google Scholar 

  35. Tauro JC. Arthroscopic “interval slide” in the repair of large rotator cuff tears. Arthroscopy. 1999;15(5):527–30.

    Article  CAS  PubMed  Google Scholar 

  36. Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ. Part I: footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg. 2007;16(4):461–8.

    Article  Google Scholar 

  37. Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ. Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg. 2007;16(4):469–76.

    Article  Google Scholar 

  38. Park MC, Idjadi JA, Elattrache NS, Tibone JE, McGarry MH, Lee TQ. The effect of dynamic external rotation comparing 2 footprint-restoring rotator cuff repair techniques. Am J Sports Med. 2008;36(5):893–900.

    Article  PubMed  Google Scholar 

  39. Park MC, Pirolo JM, Park CJ, Tibone JE, McGarry MH, Lee TQ. The effect of abduction and rotation on footprint contact for single-row, double-row, and modified double-row rotator cuff repair techniques. Am J Sports Med. 2009;37(8):1599–608.

    Article  PubMed  Google Scholar 

  40. Burkhart SS, Adams CR, Burkhart SS, Schoolfield JD. A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. Arthroscopy. 2009;25(3):274–81.

    Article  PubMed  Google Scholar 

  41. Quigley RJ, Gupta A, JH O, Chung KC, McGarry MH, Gupta R, et al. Biomechanical comparison of single-row, double-row, and transosseous-equivalent repair techniques after healing in an animal rotator cuff tear model. J Orthop Res. 2013;31(8):1254–60.

    Article  PubMed  Google Scholar 

  42. Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ. Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg. 2014;23(4):586–97.

    Article  Google Scholar 

  43. Burkhart SS, Danaceau SM, Pearce CE Jr. Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy. 2001;17(9):905–12.

    Article  CAS  PubMed  Google Scholar 

  44. Burkhart SS. The principle of margin convergence in rotator cuff repair as a means of strain reduction at the tear margin. Ann Biomed Eng. 2004;32(1):166–70.

    Article  PubMed  Google Scholar 

  45. Denard PJ, Burkhart SS. A load-sharing rip-stop fixation construct for arthroscopic rotator cuff repair. Arthrosc Tech. 2012;1(1):e37–42.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Burkhart SS, Denard PJ, Konicek J, Hanypsiak BT. Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears. Am J Sports Med. 2014;42(2):457–62.

    Article  PubMed  Google Scholar 

  47. Sonnabend DH, Howlett CR, Young AA. Histological evaluation of repair of the rotator cuff in a primate model. J Bone Joint Surg Br. 2010;92(4):586–94.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, 78234, USA

    Andrew J. Sheean

  2. The San Antonio Orthopaedic Group, Burkhart Research Institute for Orthopaedics (BRIO), San Antonio, TX, USA

    Robert U. Hartzler & Stephen S. Burkhart

Authors
  1. Andrew J. Sheean
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert U. Hartzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen S. Burkhart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew J. Sheean .

Editor information

Editors and Affiliations

  1. Domus Nova Clinic, Ravenna, Ravenna, Italy

    Gianezio Paribelli

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Sheean, A.J., Hartzler, R.U., Burkhart, S.S. (2017). Massive Rotator Cuff Lesion: Arthroscopic Repair. In: Paribelli, G. (eds) Latissimus Dorsi Transfer. Springer, Cham. https://doi.org/10.1007/978-3-319-61946-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61946-0_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61945-3

  • Online ISBN: 978-3-319-61946-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation