Massive Rotator Cuff Tears: Pathomechanics, Current Treatment Options, and Clinical Outcomes

Authors:

Joshua A Greenspoon, Maximilian Petri, Ryan J Warth, Peter J Millett

Abstract:

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The reported prevalence of massive rotator cuff tears has been as high as 40% of all rotator cuff tears. Studies have indicated a higher rate of recurrent tearing for massive rotator cuff tears after surgery compared with smaller tears. Adding to the complexity of the treatment of massive rotator cuff tears is the fact that structural failure does not always equate to clinical failure.

Many classification systems have been proposed to help guide the evaluation and treatment of massive rotator cuff tears. DeOrio and Cofield classified massive rotator cuff tears as tears that are >5 cm in size in either the anterior-posterior or medial-lateral dimension, whereas Gerber defined massive tears as those involving complete tears of at least 2 tendons. Davidson and Burkhart recently proposed a classification system linking rotator cuff tear patterns to treatment and prognosis. No consensus currently exists as to which classification system is best, and it is important to interpret the tear pattern information in light of the patient’s clinical situation.

Numerous surgical management options are available to treat massive rotator cuff tears, including nonoperative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete repair, partial repair, patch augmentation, superior capsular reconstruction, muscle- tendon transfer, and reverse total shoulder arthroplasty (rTSA). Figure 1 provides a summary of surgical treatment options for massive rotator cuff tears. To achieve the best outcomes for a patient, the orthopedic surgeon should have a good understanding of the indications for and clinical outcomes of the various treatment modalities.

For the complete study: Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Massive Rotator Cuff Tears: Pathomechanics, Current Treatment Options, and Clinical Outcomes

Authors:

Abstract:

About the Author: Peter Millett, MD