title: [How to treat massive rotator cuff tears].
abstract: The treatment of massive rotator cuff tears must be adapted to the patient's individual needs and preoperative parameters to achieve the best outcome. First, the shoulder surgeon has to determine whether a direct transosseous repair is possible. If there is not enough remaining tissue, the tissue is atrophic, and the tendon stump can be reduced only with great tension, one can use a margin convergence technique for partial closure, perform a biceps tendoplasty, or perform local tendon transfers with the subscapularis or infraspinatus muscle. If the defect cannot be sufficiently closed, elderly patients with low demands can be treated with tubercleplasty/subacromial decompression, whereas patients younger than 60 years with higher demands should receive muscle and tendon transfers. A balanced posterosuperior defect can be reconstructed by a deltoid muscle transfer, in contrast to an unbalanced one, which is best treated with an active transfer of the latissimus dorsi muscle and tendon. Anterosuperior defects can be addressed by a pectoralis muscle transfer. If the humeral head is superiorly migrated, if signs of osteoarthritis are present, and if the patient is older than 70 years, a reverse prosthesis can be implanted as a salvage procedure.
authors: Sektion Schulter und Ellenbogenchirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Deutschland. philip.kasten@ok.uni-heidelberg.de
authors: P
authors: P
authors: Kasten
authors: M
authors: M
authors: Loew
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D005858:Germany; D006801:Humans; D010818:Practice Patterns, Physicians'; D019651:Plastic Surgery Procedures / Q000379:methods*; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D019534:Shoulder Impingement Syndrome / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*
references: Clin Orthop Relat Res. 1992 Feb;(275):152-60
references: 1735206
references: Clin Biomech (Bristol, Avon). 2004 May;19(4):350-7
references: 15109754
references: Clin Orthop Relat Res. 1990 May;(254):81-6
references: 2323151
references: Z Orthop Ihre Grenzgeb. 2003 Mar-Apr;141(2):177-81
references: 12695954
references: Arch Surg. 1971 May;102(5):483-5
references: 5580339
references: J Bone Joint Surg Am. 1995 Jan;77(1):10-5
references: 7822341
references: J Bone Joint Surg Am. 2003 Oct;85-A(10 ):1944-51
references: 14563802
references: Clin Orthop Relat Res. 2002 Oct;(403):93-9
references: 12360013
references: J Bone Joint Surg Br. 2004 Apr;86(3):388-95
references: 15125127
references: J Shoulder Elbow Surg. 2003 Nov-Dec;12 (6):550-4
references: 14671517
references: Orthop Clin North Am. 1997 Jan;28(1):117-24
references: 9024436
references: J Shoulder Elbow Surg. 2001 May-Jun;10 (3):199-203
references: 11408898
references: J Bone Joint Surg Br. 2006 Apr;88(4):489-95
references: 16567784
references: J Bone Joint Surg Am. 2004 Dec;86-A(12 ):2764-76
references: 15590865
references: J Bone Joint Surg Am. 2004 Feb;86-A(2):219-24
references: 14960664
references: J Bone Joint Surg Am. 2006 Feb;88(2):403-10
references: 16452754
references: J Bone Joint Surg Am. 1992 Jun;74(5):713-25
references: 1624486
references: J Bone Joint Surg Am. 2003 Apr;85-A(4):690-6
references: 12672846
references: Clin Biomech (Bristol, Avon). 2004 Feb;19(2):116-22
references: 14967573
references: Arthroscopy. 1993;9(6):611-6
references: 8305096
references: Clin Orthop Relat Res. 1987 Jan;(214):160-4
references: 3791738
references: Acta Orthop Scand. 1996 Jun;67(3):264-8
references: 8686465
references: Int Orthop. 2007 Feb;31(1):11-5
references: 16691385
references: J Bone Joint Surg Am. 1985 Jul;67(6):974-9
references: 4019548
references: Surg Clin North Am. 1963 Dec;43:1523-30
references: 14090198
references: Acta Orthop Belg. 1994;60(1):94-100
references: 8171993
references: Rev Chir Orthop Reparatrice Appar Mot. 2002 Jun;88(4):365-72
references: 12124536
references: J Bone Joint Surg Am. 2001 Jan;83-A(1):71-7
references: 11205861
references: Orthopade. 2006 Jan;35(1):102-6
references: 16205887
references: Orthop Clin North Am. 1997 Apr;28(2):195-203
references: 9113715
references: Clin Orthop Relat Res. 1988 Jul;(232):51-61
references: 3383502
references: J Shoulder Elbow Surg. 1999 Sep-Oct;8(5):430-7
references: 10543595
references: J Bone Joint Surg Am. 1995 Jun;77(6):857-66
references: 7782358
references: Clin Orthop Relat Res. 1994 Jul;(304):78-83
references: 8020238
references: Int Orthop. 2004 Aug;28(4):226-30
references: 15168082
references: Arthroscopy. 1994 Aug;10 (4):363-70
references: 7945631
references: J Bone Joint Surg Am. 1983 Dec;65(9):1232-44
references: 6654936
references: J Bone Joint Surg Am. 1983 Apr;65(4):456-60
references: 6833319
references: J Bone Joint Surg Am. 1997 May;79(5):715-21
references: 9160944
references: J Bone Joint Surg Am. 2005 Aug;87(8):1697-705
references: 16085607
references: J Bone Joint Surg Am. 2000 Mar;82(3):372-82
references: 10724229
references: J Shoulder Elbow Surg. 1999 Jul-Aug;8(4):296-9
references: 10471998
references: J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):541-9
references: 12469077
references: J Bone Joint Surg Br. 2006 Feb;88(2):208-12
references: 16434526
references: Knee Surg Sports Traumatol Arthrosc. 2006 Apr;14 (4):365-72
references: 16307290
references: J Bone Joint Surg Am. 2006 Aug;88(8):1742-7
references: 16882896
references: J Bone Joint Surg Br. 1996 Sep;78(5):761-6
references: 8836066
references: J Bone Joint Surg Am. 2006 Aug;88(8):1699-704
references: 16882890
references: J Shoulder Elbow Surg. 2003 Jan-Feb;12(1):1-5
references: 12610477
references: Arthroscopy. 1993;9(2):195-200
references: 8461081
references: Surg Gynecol Obstet. 1982 May;154(5):667-72
references: 7071702
references: J Bone Joint Surg Am. 2000 Mar;82(3):304-14
references: 10724223
references: Arthroscopy. 1996 Jun;12(3):335-8
references: 8783829
references: J Bone Joint Surg Am. 2000 Apr;82(4):505-15
references: 10761941
references: J Bone Joint Surg Am. 2006 Jan;88(1):113-20
references: 16391256
references: Acta Orthop Belg. 1995;61 Suppl 1:112-9
references: 8623590