It is recognized that for many patients, non-operative management can substantially improve the comfort and function of the shoulder with a chronic massive tear (see Nonoperative treatment of chronic, massive irreparable rotator cuff tears: a systematic review with synthesis of a standardized rehabilitation protocol). For patients with painful massive, irreparable rotator cuff tears having retained active elevation of the arm, a conservative procedure, the "smooth and move" (see this link), can provide significant benefit and prompt return to activities without the complexity or the risks associated with more aggressive surgeries
Some surgeons advocate attempting partial repair of the massive cuff defect. The authors of Massive and irreparable rotator cuff tears treated by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only suggested that partial repair with augmentation using the long head of the biceps would result in a better quality of tendon to bone healing and improved clinical, functional and radiological outcomes for patients with chronic, massive and irreparable rotator cuff tears involving both the supraspinatus and infraspinatus tendons. Irreparability was defined intraoperatively as the inability to achieve sustainable repair of the supraspinatus after complete release,
The augmented group consisted of 30 patients whose biceps long head tendon was intact (only minimal redness, fraying and stable proximal attachment) on intraoperative assessment.
The non-augmented group consisted of 30 patients with poor biceps tendon quality, tendon dislocation or absence of the tendon.
As assessed by MRI at one year after surgery, the retear rate for was 43.3% for the augmented group and 73.3% for the non-augmented group.
In spite of these imaging findings, there were no significant differences between the groups in patients' postoperative shoulder range of motion, strength, Hamada classification, Simple Shoulder Test (SST) scores and postoperative Goutallier scales. The Constant score (CMS) averaged 76.2±0.9 for the augmented group and 70.9±11.5 for the non-augmented group, but this difference failed to reach clinical significance ( the minimal clinically important difference is >10 for the CMS (see Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery)).
Of note, the augmented and non-augmented groups were not comparable. For example, two thirds of the augmented patients were male, whereas less than half of the non-augmented patients were male. The pathologies were different: the augmented patients had intact biceps tendons while the non-augmented patients did not; the size and retraction of the rotator cuff tendons are not reported. Data are not presented on the preoperative strength or range of motion.
Comment: If we are to be able to discuss management options for our patients with these tears, we will need comparative clinical studies of patients that are similar before treatment is begun. Only in this way will we have the basis for understanding the relative effectiveness of physical therapy, smooth and move, subacromial balloon catheters, superior capsular reconstruction, partial cuff repairs (without and with augmentation) and reverse total shoulder arthroplasty. The need for controlled studies can be seen in this article: Subacromial Balloon Spacer - what is the evidence supporting the value of this innovation to patients with irreparable cuff tears?
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
