Atraumatic cuff tear: Tendons that fail with minimal force are by definition of suboptimal quality. "Repairing" these tears does not restore the tendon to normal quality any more than sewing up holes in worn jeans restores them to their original quality. Furthermore, repairing large tears when there is tissue missing comes at the expense of tightening and putting the repair under tension which may, in turn, challenge the repair.
Chronic cuff tear: A rotator cuff tear that has been present for over several months is chronic. The longer the duration of the tear, the more likely that tendon quantity and quality have been lost. The longer the duration of the tear, the more likely that the muscle attached to the tendon has atrophied. So, in this situation the surgeon has time to consider what is causing the symptoms. Is the patient's problem primarily weakness, catching/popping, stiffness, or cuff tear arthropathy.? The thing to realize is that with chronic rotator cuff tears, there is time to try non-operative management. If the shoulder is weak or stiff, the patient can try some simple home excises as shown in this link.
If the shoulder remains stiff or if catching/popping is troublesome for patient, a 'smooth and move' is a strong consideration when the tendon lacks the quantity and quality for a robust and durable rotator cuff repair. This procedure may not only release adhesions and resolve subacromial roughness, it may also lessen pain by removing the thick bursal tissue often associated with chronic cuff tears. The smooth and move has the advantage of allowing active use of the shoulder immediately after surgery, without the prolonged period of immobilization that is necessary to protect a rotator cuff repair or a reconstruction. In performing this procedure it is important to avoid a 'decompression' or 'acromioplasty' in that these procedures put the shoulder at risk for instability, anterosuperior escape, and pseudoparalysis as shown below.
