Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

Authors:

Joshua A Greenspoon, Peter J Millett, Samuel G Moulton, Maximilian Petri

Abstract:

Tears of the rotator cuff are a common cause of shoulder pain and dysfunction. Although the prevalence of rotator cuff tears increase with age, not all patients develop symptoms necessitating surgery, and many patients benefit from conservative management. However, if symptoms persist, surgery can provide significant pain relief and improvements in function across many patient ages and demographics.

Massive rotator cuff tears are particularly challenging to manage clinically, which is concerning given that they have a reported prevalence to be as high as 40% of all rotator cuff tears. One difficulty is that many classification systems have been proposed to assist in the evaluation and treatment of massive cuff tears, however, no consensus currently exists. A commonly used classification system is one originally proposed by DeOrio and Cofield which defines a massive tear as one that is greater than 5 centimeters in size. A classification system used often in Europe was one defined by Gerber in which a rotator cuff tear is considered massive if it is a full thickness tear involving at least two tendons. A recent classification system proposed by Davidson and Burkhart links rotator cuff tear patterns to treatment and prognosis. Millett and Warth emphasize that it is crucial that management of the patient with a rotator cuff tear be based on an interpretation of the clinical situation and patient presentation.

Another challenge when treating massive tears is that several studies have indicated a higher rate of structural failure of repairs when compared to smaller tears. However, it is important to note that even patients with retears noted postoperatively on magnetic resonance imaging (MRI) had significantly improved function and pain. Therefore, it has to be emphasized that structural failure does not necessarily equate to a clinical failure. Many surgical treatment options exist for managing massive tears, including arthroscopic debridement with a biceps tenotomy or tenodesis, complete repair if the rotator cuff tendon is of good quality and not severely retracted, partial repair, use of an allograft patch to augment a repair or to bridge over a defect, superior capsular reconstruction, muscle tendon transfer, and reverse total shoulder arthroplasty. The purpose of this article is to highlight the indications and clinical outcomes of muscle tendon transfers in the treatment of massive irreparable rotator cuff tears.

For the complete study: Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

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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Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

Authors:

Abstract:

About the Author: Peter Millett, MD