This is a retrospective series of 61 patients with massive rotator cuff tears (≥2 tendons, ≥5 cm) repaired at Columbia-Presbyterian. Every patient had subacromial decompression plus mobilization and tendon-to-bone repair, followed for a mean of 7 years. The question: can massive tears achieve durable pain relief and function with a tissue-preserving open technique?
When you counsel a patient with a massive cuff tear, separate two promises: pain relief is highly reliable and independent of size, but strength and overhead endurance depend on how many tendons are torn.
This paper codifies the technical checklist still taught today. Adequate anterior acromioplasty, preserve the deltoid origin, mobilize rather than debride the cuff, and reattach to a shallow trough at the anatomic neck.
The interval slide is the key mobilization pearl: releasing the coracohumeral ligament and rotator interval to the coracoid buys 1 to 1.5 cm of lateral supraspinatus excursion, and should be tried before resorting to subscapularis transfer. Timing is actionable. In traumatic tears, every unsatisfactory result occurred beyond 6 months, so do not sit on an acute massive tear.
Finally, respect the rehab timeline. Resistive exercise is delayed 8 weeks to protect tendon-to-bone healing, and full strength can take 12 to 18 months.
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This is a retrospective series of 61 patients with massive rotator cuff tears (≥2 tendons, ≥5 cm) repaired at Columbia-Presbyterian. Every patient had subacromial decompression plus mobilization and tendon-to-bone repair, followed for a mean of 7 years. The question: can massive tears achieve durable pain relief and function with a tissue-preserving open technique?
When you counsel a patient with a massive cuff tear, separate two promises: pain relief is highly reliable and independent of size, but strength and overhead endurance depend on how many tendons are torn.
This paper codifies the technical checklist still taught today. Adequate anterior acromioplasty, preserve the deltoid origin, mobilize rather than debride the cuff, and reattach to a shallow trough at the anatomic neck.
The interval slide is the key mobilization pearl: releasing the coracohumeral ligament and rotator interval to the coracoid buys 1 to 1.5 cm of lateral supraspinatus excursion, and should be tried before resorting to subscapularis transfer. Timing is actionable. In traumatic tears, every unsatisfactory result occurred beyond 6 months, so do not sit on an acute massive tear.
Finally, respect the rehab timeline. Resistive exercise is delayed 8 weeks to protect tendon-to-bone healing, and full strength can take 12 to 18 months.