This case series introduces partial repair for massive irreparable rotator cuff tears. Instead of covering the entire defect, the surgeon repairs the anterior and posterior margins to restore the shoulder's force couples. The goal is to convert a dysfunctional tear into a biomechanically intact functional cuff tear.
When you face a massive tear that cannot be fully mobilized, the instinct is to cover the hole at any cost. This paper reframes the goal: restore the force couples, not the coverage.
The mental model is the suspension bridge. The rotator cable spans anterior to posterior, and balancing the subscapularis against the infraspinatus-teres minor complex rebalances the transverse plane force couple. That gives the deltoid a stable fulcrum, which is why elevation and strength improve.
Use the exam to select candidates. A positive lift-off with strong external rotators, or an intact lift-off with weak external rotators, marks the imbalance that partial repair corrects. Avoid the classic trap of transposing intact subscapularis superiorly. That shifts the muscle's line of action above the center of rotation and destroys the coronal force couple, driving superior migration.
Remember that a residual defect is not inherently painful; edge instability is the more likely pain source.
This case series introduces partial repair for massive irreparable rotator cuff tears. Instead of covering the entire defect, the surgeon repairs the anterior and posterior margins to restore the shoulder's force couples. The goal is to convert a dysfunctional tear into a biomechanically intact functional cuff tear.
When you face a massive tear that cannot be fully mobilized, the instinct is to cover the hole at any cost. This paper reframes the goal: restore the force couples, not the coverage.
The mental model is the suspension bridge. The rotator cable spans anterior to posterior, and balancing the subscapularis against the infraspinatus-teres minor complex rebalances the transverse plane force couple. That gives the deltoid a stable fulcrum, which is why elevation and strength improve.
Use the exam to select candidates. A positive lift-off with strong external rotators, or an intact lift-off with weak external rotators, marks the imbalance that partial repair corrects. Avoid the classic trap of transposing intact subscapularis superiorly. That shifts the muscle's line of action above the center of rotation and destroys the coronal force couple, driving superior migration.
Remember that a residual defect is not inherently painful; edge instability is the more likely pain source.