Patch-Augmented Rotator Cuff Repair and Superior Capsule Reconstruction

The success of surgical rotator cuff repair has been associated with a number of factors including size of the tear, tendon quality, degree of retraction, and fatty infiltration. Massive rotator cuff tears in active patients with minimal glenohumeral arthritis remain a particular challenge for the treating surgeon. If the rotator cuff tear is not able to be repaired, often, a reverse shoulder arthroplasty or a tendon transfer is performed; however both procedures have rather high complication rates and debatable long-term results, particularly in younger patients. Arthroscopic treatment options
for patients without significant glenohumeral arthritis include debridement with or without a biceps tenotomy or tenodesis, partial rotator cuff repair, graft augmentation or interposition, or superior capsule reconstruction. These options can either be performed as bridging procedures, delaying the need for more invasive surgery in young and active patients, or as definitive solutions for patients with severe comorbidities to avoid higher perioperative risks associated with reverse shoulder arthroplasty or tendon transfers.