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Surgical Management of Irreparable Rotator Cuff Tears

What Works, What Does Not, and What Is Coming

Burnier, Marion MD1; Elhassan, Bassem T. MD1; Sanchez-Sotelo, Joaquin MD, PhD1

doi: 10.2106/JBJS.18.01392
Current Concepts Review

  • ➤ The term functionally irreparable rotator cuff tear (FIRCT) is intended to capture patients who would experience failure of an attempted primary rotator cuff repair because of the extent of cuff muscle and tendon damage and other patient-related factors.
  • ➤ Debridement, biceps tenodesis, and/or partial repair of the torn rotator cuff may reduce pain and improve function for selected patients with a FIRCT.
  • ➤ Static soft-tissue restraints to abnormal glenohumeral head translation, such as implantation of an absorbable balloon in the subacromial space or superior capsular reconstruction (SCR), appear to reduce pain and improve function, although some have reported a relatively high structural failure rate with SCR.
  • ➤ When improvement of strength is the primary goal of treatment, tendon transfers provide a viable treatment alternative; most tendon transfers for management of a FIRCT are currently performed with arthroscopically assisted techniques.
  • ➤ Transfer of the lower portion of the trapezius has emerged as a successful alternative to transfer of the latissimus dorsi, whereas transfer of the latissimus dorsi to the lesser tuberosity is being explored as an alternative to transfer of the pectoralis major for functionally irreparable subscapularis tears.

1Mayo Clinic, Rochester, Minnesota

Email address for J. Sanchez-Sotelo:

Investigation performed at the Mayo Clinic, Rochester, Minnesota

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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