Need exists for an improved massive RCT repair technique to maximise both repair success and patient outcomes
Good to excellent clinical outcomes and high healing rates have long been achieved in arthroscopic and mini open rotator cuff repair for small- to medium-sized rotator cuff tears (RCTs)2, 31, 34, 39. However, high failure rates persist for large to massive RCTs 12, 19, 37. Whether we should aim for complete or partial repair for massive RCTs is controversial and while some surgeons have designed ingenious procedures to improve healing after massive RCT repair, the question remains whether their excellent results depend on their skill more than technique27, 38.
Associated with poorer outcomes and increased failure following rotator cuff repair is the presence of high muscle tension at the repair site9. In addressing this, some surgeons e.g. Debeyre et al10 have reported using a technique in which the supraspinatus (SSP) muscle is elevated from the supraspinatus fossa and advanced laterally. While this decreases the tension of the distal SSP tendon with acromial osteotomy, the technique involves very invasive surgery and runs the risk of complications including nonunion at the osteotomy site41. In addition, only SSP muscles are advanced, not infraspinatus (ISP) muscles which is problematic given massive tears usually involve both. Further to this, Warner et al40 point out that suprascapular nerve (SSN) palsy may occur with excessive advancement of SSP muscles.
There appears to be a clear need for an improved massive RCT repair technique which takes into account both SSP and ISP muscles and is minimally invasive. Such a technique which is also simple and efficient would increase the probability of repair success and help maximize surgical outcomes for these patients.