An Algorithmic Approach to the Surgical Management of Massive Rotator Cuff Tears Based on Imaging, Function, and Repairability.

Massive rotator cuff tears are one the most challenging conditions to treat in the shoulder. A variety of surgical approaches have been used to manage massive rotator cuff tears, such as repair with or without augmentation, superior capsule reconstruction, tendon transfer, and reverse shoulder arthroplasty. The choice between joint preservation or reverse shoulder arthroplasty is first considered based on preoperative imaging and functional status, as well as patient factors. When joint preservation is the goal of treatment, a combination of repairability, patient function, and age can be used to provide an algorithmic approach to treatment. LEVEL OF EVIDENCE: Level V, expert opinion.