The advantages of using the arthroscope in treating small and medium tears include articular evaluation, avoidance of deltoid detachment, and reduced complications of stiffness and infection. The indications can be extended to treat the massive rotator cuff tear.
Massive rotator cuff tears include disruption of 3 tendons or a multiple-tendon tear with retraction to the glenoid rim. Two patterns include anterosuperior avulsion or chronic posterosuperior U-shaped tears.
During a 10-year period, 124 shoulders with massive tears were treated arthroscopically. One hundred and nine patients had complete closure, 15 had partial repair, 3 had graft augmentation, 5 had biceps tenotomy, and 16 patients had biceps tenodesis.
Patients had pain relief and satisfaction in 89% and return of active motion in 88%. Additional releases and tuberosity fixation with rehabilitation delay increased successful closure of massive tears (67%). Persistence of weakness was common in chronic tears, which was felt to be related to delay in repair, muscular atrophy, and suprascapular nerve deficits in some. Early intervention is preferred to increase the likelihood of repair due to better tendon mobility, allowing for additional fixation.