The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option.
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Suppression of inflammatory macrophages is a potential strategy to improve rotator cuff healing and has shown promise in preclinical models.
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HSS Sports Medicine Institute, Hospital for Special Surgery; Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery Research Institute. Electronic address:
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Physician, Peachtree Orthopaedic Clinic, Atlanta, GA, USA.
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Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
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