Arthroscopic approach to massive rotator cuff tears.

The treatment of a patient with a painful massive rotator cuff tear can be challenging. Massive tears exceed 5 cm in length and involve partial or complete tearing of three tendons. The arthroscopic approach provides a minimally invasive technique to evaluate the tear, mobilize and repair tendons, and improve symptoms without disruption of the deltoid. The arthroscopic technique can create a low-tension repair. The reduction of postoperative motion provides the best environment for tendon-to-bone reattachment. Procedures that have reduced rates of adhesion formation allow for this protection with a minimal risk of stiffness. Reduction of the boutonniere effect of superior head migration leads to improved arm elevation. Strength deficits are common and relate to muscle and tendon deterioration that may not be reversible, even with successful closure of the tear. Weakness caused by suprascapular neuropathy may improve after the position and length of the posterosuperior cuff tendons are reestablished. Arthroscopic options include rotator cuff repair, partial cuff repairs, xenografts, decompression, débridement, biceps tenotomy, tenodesis, and use in autografting.