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The Journal of Bone and Joint Surgery 82:878 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Management of Massive Irreparable Rotator Cuff Tears: The Role of Tendon Transfer*{dagger}

Jon J. P. Warner, M.D{ddagger}

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 A.M.-5 P.M., Central time).
{ddagger}Massachusetts General Hospital, Professional Office Building, Suite 403, 275 Cambridge Street, Boston, Massachusetts 02114. E-mail address: jwarner@partners.org.


   The Problem
 
Most rotator cuff tears can be repaired by conventional methods. Even in the case of massive tears, repair or reconstruction is usually feasible and the outcome is usually good1,2. While there is no universal agreement on the definition, in North America Cofield's3 definition of a massive tear as one with a diameter of five centimeters or greater is used. Furthermore, there appear to be two distinct patterns of tears, each with a different epidemiology, mechanism of injury, associated disability, and prognosis4. The more common, posterior-superior configuration involves the supraspinatus and the infraspinatus, and the less common, anterior-superior configuration involves the subscapularis and the supraspinatus.

Massive posterior-superior rotator cuff tears are not common. Even in clinical practices limited to the treatment of shoulder problems, less than one-third of all rotator cuff tears are massive. Neer5 reported that, of 340 rotator cuff tears operated on over a thirteen-year period, 145 . . . [Full Text of this Article]


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