Management of Irreparable Massive Rotator Cuff Tears. A Systematic Review and Meta-analysis of Patient-reported Outcomes, Reoperation Rates, and Treatment Response

Treatment Strategies for Irreparable Massive Rotator Cuff Tears: A Comparative Study


Irreparable massive rotator cuff tears (MRCTs) present a significant challenge in orthopedic surgery. The study under review [1] aims to compare the effectiveness of various treatment strategies for MRCTs, including physical therapy, partial repair, graft interposition, tendon transfer, superior capsular reconstruction (SCR), balloon arthroplasty, and reverse shoulder arthroplasty (RSA).


The study is a systematic review and meta-analysis of 43 studies, including randomized controlled trials and retrospective studies. The treatment strategies were evaluated based on their clinical outcomes, survival rates, and complications.


  1. Physical Therapy: Physical therapy, compared to surgical treatments, may have inferior outcomes. 60% of the patients did not respond to physical therapy or went on to have surgery.
  2. Partial Repair and Debridement: These strategies showed improvements in pain scores, functional range of motion, and patient-reported outcomes (PROs) with lower reoperation rates compared to physical therapy. However, partial repair had a high re-tear rate (45%).
  3. Graft Interposition and Tendon Transfer: These surgical reconstructions showed superior improvements in pain scores, forward elevation, and mean change in CMS and ASES scores compared to physical therapy. However, open tendon transfer may not be a successful treatment strategy as the majority of studies did not meet the minimal clinically important difference (MCID) for either ASES or CMS.
  4. Superior Capsular Reconstruction (SCR) and Balloon Arthroplasty: Both SCR and balloon arthroplasty led to an improvement in pain scores, forward elevation, and PRO scores. However, SCR using human dermal allograft had a high structural failure rate.
  5. Reverse Shoulder Arthroplasty (RSA): RSA improved pain scores, functional motion, and PRO scores compared to physical therapy. However, this treatment strategy has an 8.2% reoperation rate and a 10.1% prosthesis failure rate.


The study highlights the absence of high-quality literature on irreparable MRCTs, making it difficult to definitively recommend one treatment strategy over another. Treatment decisions should be guided by clinical experience, patient factors, patient expectations, and rotator cuff tear characteristics. The study also emphasizes the need for standardized data collection, reporting, and terminology to enhance the quality of evidence-based medicine.


Due to the paucity of high-quality clinical studies available for guiding management of irreparable MRCTs, it is currently not possible to recommend for or against any specific treatment strategy. Significant opportunities exist for multi-center research groups to embark on high-quality comparative clinical studies to improve our understanding and management of MRCTs.


  1. Treatment Strategies for Irreparable Massive Rotator Cuff Tears: A Comparative Study

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© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow