This ASES MERIT Investigators systematic review searched four databases and included 43 studies across eight treatment strategies for irreparable massive rotator cuff tears. It compares patient-reported outcomes, failure rates, and whether treatment changes exceed MCID thresholds for the Constant-Murley and ASES scores. The goal is to determine whether any treatment can be recommended over another based on current evidence.
When a patient with an irreparable massive rotator cuff tear sits across from you, understand that the entire evidence base guiding your decision is level IV case series — there is no high-quality data to definitively favor one operation over another.
If you offer physical therapy first, counsel the patient that 60% will fail or progress to surgery. It is appropriate for those who are medically unfit or who want to trial non-operative care, but it is not a reliable definitive treatment.
When operating, graft interposition has the strongest MCID-benchmarked evidence and should be considered. If you perform latissimus dorsi transfer, use greater tuberosity footprint fixation. Bone tunnel fixation carries a 77% failure rate and the data on this are unambiguous.
For superior capsular reconstruction, prefer tensor fascia lata autograft over human dermal allograft: allograft structural failure ranges from 15-75% across published series. Reverse shoulder arthroplasty is a legitimate option, but its 10.1% prosthesis failure rate means it belongs in elderly patients with pseudoparalysis. Not as a first-line reconstruction in younger, active patients.
This ASES MERIT Investigators systematic review searched four databases and included 43 studies across eight treatment strategies for irreparable massive rotator cuff tears. It compares patient-reported outcomes, failure rates, and whether treatment changes exceed MCID thresholds for the Constant-Murley and ASES scores. The goal is to determine whether any treatment can be recommended over another based on current evidence.
When a patient with an irreparable massive rotator cuff tear sits across from you, understand that the entire evidence base guiding your decision is level IV case series — there is no high-quality data to definitively favor one operation over another.
If you offer physical therapy first, counsel the patient that 60% will fail or progress to surgery. It is appropriate for those who are medically unfit or who want to trial non-operative care, but it is not a reliable definitive treatment.
When operating, graft interposition has the strongest MCID-benchmarked evidence and should be considered. If you perform latissimus dorsi transfer, use greater tuberosity footprint fixation. Bone tunnel fixation carries a 77% failure rate and the data on this are unambiguous.
For superior capsular reconstruction, prefer tensor fascia lata autograft over human dermal allograft: allograft structural failure ranges from 15-75% across published series. Reverse shoulder arthroplasty is a legitimate option, but its 10.1% prosthesis failure rate means it belongs in elderly patients with pseudoparalysis. Not as a first-line reconstruction in younger, active patients.