Management of Massive Rotator Cuff Tears
Surgical management of massive rotator cuff tears remains challenging, and failure occurs in 20% to 90% of patients. Multiple surgical techniques have been described; there is no current gold standard. Treatment options include debridement with possible biceps tenotomy/tenodesis, partial repair, muscle transfer, tissue interposition, and repair with patch augmentation. Other potential solutions include hemiarthroplasty and reverse total shoulder arthroplasty; however, these solutions are not ideal for young patients with minimal glenohumeral articular disease. Patch augmentation has been described as a technique to augment the biology of rotator cuff repair (RCR), with promising short- term results.
Arthroscopic Rotator Cuff Repair Patch Augmentation
Arthroscopic RCR with patch augmentation is best used in situations involving poor tissue quality with massive rotator cuff tears, tears of 2 or more tendons, and failed primary repair and/or revision rotator cuff surgery (Table 1). The purpose of this article is to provide our preferred surgical technique for arthroscopic RCR with patch augmentation. We postulate that this stepwise approach (Table 2) which involves carefully selected portal placement facilitates ease of suture passage, organization, and patch fixation while avoiding the morbidity of an open approach.