Treatment of Irreparable Rotator Cuff Tear
It is an option to perform partial rotator cuff repair, debridement, or muscle transfers for patients with irreparable rotator cuff tears when surgery is indicated.
Rationale
Five Level IV 99-103 studies addressed the use of operative debridement, limited repair, or muscle transfer for an irreparable rotator cuff tear. These studies found an improvement in pain and function after repair of a portion of a chronic full thickness rotator cuff tear when a complete repair can not be achieved.99 They also found clinically important improvement with arthroscopic debridement without partial repair of the rotator cuff with or without release of the long head of the biceps102 and improvement in pain and function with transfer of the latissimus or teres major for irreparable tears involving the supraspinatus and infraspinatus tendons.100 Comparative studies on the superiority of one surgical technique or option over another for surgical management of irreparable full thickness rotator cuff tears have not been reported. All studies reported intermediate term results 3-4 years after surgical treatment. Long term results were not reported. Complications reported after muscle transfer include temporary Complex Regional Pain Syndrome and cosmetic deformity of the biceps.
- (100) Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy 2002;18(5):454-463.
- (101) Guven O, Bezer M, Guven Z, Gokkus K, Tetik C. Surgical technique and functional results of irreparable cuff tears reconstructed with the long head of the biceps tendon. Bull Hosp Jt Dis 2001;60(1):13-17.
- (102) Klinger HM, Spahn G, Baums MH, Steckel H. Arthroscopic debridement of irreparable massive rotator cuff tears--a comparison of debridement alone and combined procedure with biceps tenotomy. Acta Chir Belg 2005;105(3):297-301.
- (103) Klinger HM, Steckel H, Ernstberger T, Baums MH. Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Arch Orthop Trauma Surg 2005;125(4):261-266.
- (99) Celli A, Marongiu MC, Rovesta C, Celli L. Transplant of the teres major in the treatment of irreparable injuries of the rotator cuff (long-term analysis of results). Chir Organi Mov 2005;90(2):121-132.