Irreparable Rotator Cuff Tears

Rotator cuff tears (RCT) are one of the most commonly treated orthopaedic pathologies. It is present in 20.7% of the general population, and the prevalence increases with age [1, 2]. The rate of patients with symptoms related to the shoulder affected by a cuff lesion is 36% in the general population, whereas 16.9% of the subjects without symptoms also had RCT. RCTs in the general population occur most commonly in elderly patients, male patients, the dominant arm, patients engaged in heavy labour, or patients having a history of trauma [2]. When conservative treatment fails, operative treatment is an option to improve patient condition [3, 4]. Most surgeons agree that an acute painful tear in young people should be treated operatively in order to decrease pain and provide satisfactory long-term function. However, great controversy exists with regard to tears that are large, chronic in nature, and not tractable to repair by standard means. These tears, considered “irreparable” or “massive”, provide an ongoing challenge for the orthopaedic surgeon. Authors have attempted to classify these tears based on their size and location [5]. Others consider a massive rotator cuff tear to be one involving two or more tendons. A massive tear is not necessarily irreparable, and an irreparable tear does not mean it is massive in size. However, an irreparable tear can be defined surgically as a tear in which direct tendon-to-bone repair and healing are not possible. An irreparable tear was described by Warner and Parsons [6] as “the inability to achieve a direct repair of the native tendon to the humerus despite mobilizing the soft tissues”. Small chronic tears in contradistinction to massive tears may be small and friable and unable to be repaired primarily to bone. Irreparable rotator cuff tears are usually large and retracted with nonfunctional muscle bellies and severe fatty degeneration. The true determination of an irreparable cuff tear, however, is definitively performed under direct visualization under the surgery.