Massive rotator cuff tears are defined by the amount of tissue that is torn. There are 4 rotator cuff tendons and massive tears involve at least 2 of the 4. The repairs take more time to repair and heal. Surgery is typically indicated in acute tears especially in younger and more active patients and in chronic tears that have failed nonoperative treatment. There are several repair techniques, but even in massive tears, we usually repair these tears arthroscopically with a two row technique which has been shown to have improved biomechanical strength and surface area for healing. It is cliché to say that every tear is a little different, but it many respects this is true. The tendons can be torn from the bone (most common) and within its substance. The tears can also have different shapes and tissue quality. Some patients are placed on the large/massive protocol not because of tear size but because of tissue quality.
Massive Rotator Cuff Repair Surgery
The rotator cuff tendons are repaired to the bone and to themselves. The quality of the repair is determined quality of the bone and tendon tissue and dictates how and when therapy is performed. Most of the time the patient will have arthroscopic pictures of their own surgery which can be reviewed with them if desired.
At the time of the rotator cuff repair other procedures might need to be performed. These can include a subacromial decompression which typically involves removing any bone spurring and making ample space for the rotator cuff. It can also include repairing the biceps tendon and cleaning up any other damaged tissue.
