This 2010 JBJS current concepts review from Hospital for Special Surgery systematically addresses the definition, biomechanics, workup, and full treatment spectrum for massive rotator cuff tears — from nonoperative rehabilitation through debridement, partial and complete repair, scaffold augmentation, tendon transfer, and arthroplasty — with graded evidence for each approach.
When you see a massive rotator cuff tear on MRI, immediately assess for Goutallier fatty infiltration grade, acromiohumeral interval, and static superior humeral head migration — these three findings determine whether you're dealing with a reparable tear, a candidate for tendon transfer, or an arthropathy requiring prosthetic reconstruction.
Preserve the coracoacromial ligament during any debridement procedure: resecting it in the setting of a massive tear risks catastrophic anterosuperior humeral escape.
This 2010 JBJS current concepts review from Hospital for Special Surgery systematically addresses the definition, biomechanics, workup, and full treatment spectrum for massive rotator cuff tears — from nonoperative rehabilitation through debridement, partial and complete repair, scaffold augmentation, tendon transfer, and arthroplasty — with graded evidence for each approach.
When you see a massive rotator cuff tear on MRI, immediately assess for Goutallier fatty infiltration grade, acromiohumeral interval, and static superior humeral head migration — these three findings determine whether you're dealing with a reparable tear, a candidate for tendon transfer, or an arthropathy requiring prosthetic reconstruction.
Preserve the coracoacromial ligament during any debridement procedure: resecting it in the setting of a massive tear risks catastrophic anterosuperior humeral escape.