Shoulder surgeon techniques and preferences in treatment of massive rotator cuff tears: current practices for rotator cuff repair and superior capsule reconstruction.

Background: Massive rotator cuff tears can be difficult to manage and consensus regarding treatment is debated. The purpose of this questionnaire study was to examine surgeon techniques and considerations for treatment of massive rotator cuff tears including how they implement superior capsule reconstruction (SCR), when indicated.

Methods: A 21-item questionnaire was sent to members of the American Shoulder and Elbow Surgeons and the American Orthopedic Society for Sports Medicine. Questions covered management preferences for massive rotator cuff tears, rotator cuff repair and SCR techniques, beliefs about SCR, implant choices, use of augments, demographics, and patient management scenarios.

Results: The questionnaire had 230 respondents. In rotator cuff repair of massive rotator cuff tears, preferred responses were long head biceps tendon preservation (when asymptomatic, 45.3%), routine subacromial decompression (62.1%), solid threaded anchors (71.1%), double row configuration (65.1%), and bone marrow stimulation of the footprint (55.6%). For providers that perform SCR (n = 166), preferred strategies included long head biceps tenodesis (55.4%), human dermal allograft tissue (93.2%), glenoid fixation with 3 implants (71.2%) using solid threaded anchors (42.3%), and humeral fixation with 2 solid threaded anchors medially (71.0%), and 2 solid threaded anchors laterally (46.9%). Other highly recommended strategies were side-to-side repair to the posterior rotator cuff if able (97.6%) and to use the thickest graft available (62.2%).

Conclusion: Despite improved techniques and growing interest in SCR, many questions still remain. This study identifies the significant variability in repair constructs and methodology with SCR; further investigation into these variables could be analyzed to identify best practice guidelines.