Arthroscopic management of massive rotator cuff tears

Massive, retracted tears of the rotator cuff are difficult to manage. They occur more commonly in older individuals with compromised tissues. The retracted, scarred rotator cuff tissues are not easily mobilized and repaired. The tears usually involve more than one tendon and are usually retracted to the level of the glenoid rim. Visualization of a massive tear is a challenge, even when extensile exposures are utilized. Additionally, exposure requires the release of the deltoid origin with associated morbidity and with potential detachment of the repaired deltoid. Once exposed, the torn rotator cuff tissue may not have sufficient length to be adequately mobilized and reduced anatomically. The bone and soft tissues may not be robust enough for repair. Once repaired, the damaged and weakened tissues may not withstand rigorous therapy and can tear once again.