Retrospective cohort of 19 patients with MRI-confirmed massive rotator cuff tears (6 two-tendon, 13 three-tendon) managed exclusively nonoperatively. The study tracks both clinical function and structural integrity — tear size, fatty infiltration, acromiohumeral distance, and glenohumeral OA — at an average of 48 months to define the mid-term natural history of this condition.
When counseling a patient with a massive rotator cuff tear who wants to defer or decline surgery, be explicit: function may hold for ~4 years, but structural collapse is inevitable, and roughly half of initially reparable tears become irreparable in that window — closing the door on repair and leaving only tendon transfer, débridement, or reverse arthroplasty as options.
Retrospective cohort of 19 patients with MRI-confirmed massive rotator cuff tears (6 two-tendon, 13 three-tendon) managed exclusively nonoperatively. The study tracks both clinical function and structural integrity — tear size, fatty infiltration, acromiohumeral distance, and glenohumeral OA — at an average of 48 months to define the mid-term natural history of this condition.
When counseling a patient with a massive rotator cuff tear who wants to defer or decline surgery, be explicit: function may hold for ~4 years, but structural collapse is inevitable, and roughly half of initially reparable tears become irreparable in that window — closing the door on repair and leaving only tendon transfer, débridement, or reverse arthroplasty as options.