Massive Rotator Cuff Tear Treatment Options

What is a massive rotator cuff tear?

A massive tear is defined as a full thickness tear of at least two of the four rotator cuff tendons, a full thickness tear greater than 5 centimeters in diameter, or both. A large tear is 3 centimeters in diameter. Massive rotator cuff tears account for about 40% of all rotator cuff tears, and 60% of recurrent tears. Massive rotator cuff tears are often accompanied by complicated problems that present a high rate of recurrence and explain why there is a 78% re-tear rate after surgical repair.

Most massive rotator cuff tears are chronic. Massive rotator cuff tears cannot be repaired by traditional shoulder surgery. Selection of the most appropriate treatment for each patient requires a thorough history and physical exam and a surgeon with deep understanding and experience with rotator cuff injuries and treatments.

What are the treatment options for an irreparable massive rotator cuff tear?

• Nonsurgical treatment with physical therapy, activity modification, and steroid injections. However, nonsurgical treatment can lead to osteoarthritis; and the likelihood of tear progression means only patients with low demand, those medically unfit for surgery, and those wishing to avoid surgery will be treated without surgery.
• Debridement, or simple “cleaning up” of the joint is reserved for low demand patients with limited functional goals.
• Arthroscopic cuff repair with patch augmentation. Patch augmentation has been shown to improve healing rates. Allograft augmentation has the potential to reduce the risk of retears.
• Muscle and tendon transfer is a procedure to transfer the muscle and tendon in one location to another to substitute for the lost function. This procedure is reserved for active patients with loss of strength and pain. This is open complex surgery.
• Arthroscopic superior capsular reconstruction (ASCR) is indicated for patients with symptomatic massive RCTS who have fully functioning deltoid muscles. This procedure can successfully restore stability and shoulder function needed for daily living which improves quality of life. The tendons cannot be repaired because there is insufficient tissue to repair. The shoulder capsule is reconstructed using graft tissue either from the patient or a donor. All the tendons are debrided and anchored back to bone, and a graft is used to patch the cuff capsule. It is safe and effective and the best option for active healthy patients with only minor shoulder OA. Recovery takes 8-12 months.
• Balloon arthroplasty offers optimal pain control and functional outcomes. It involves use of a biodegradable balloon spacer to restore biomechanics. It stays inflated for about 6-12 months during which the patient can complete rehabilitation from arthroscopic repair.
• Reverse Shoulder Arthroplasty is like total shoulder replacement as it replaces the ball and socket joint with implants. However, in a reverse shoulder replacement the ball is attached to shoulder bone and the socket is attached to the upper arm. It is recommended when there is arthritis in the joint and irreparable rotator cuff tendons. It is not appropriate for young, active patients.

Despite amazing advances in technology and arthroscopy, some rotator cuffs are not repairable. There is no consensus on the ideal treatment for a massive rotator cuff tear. The decision to pursue a particular treatment for a rotator cuff that cannot be repaired is based on shared decision making between the surgeon and the patient. Key to this process is the surgeon’s clinical experience, professional judgment, patient factors, patient expectations, and the patient’s ability to complete post-op rehabilitation.

Why choose Dr. Petrigliano?

Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Chargers football team and associate team physician for UCLA Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in Santa Monica California, and serves greater Los Angele and the South Bay. Contact Dr. Petrigliano to schedule a consultation today.