Arthroscopy. 2024 Jun;40(6):1906-1907. doi: 10.1016/j.arthro.2024.02.036. Epub 2024 Mar 7.
The massive irreparable rotator cuff tear remains a challenging condition for which there are many reported treatment options, including biceps tenotomy or tenodesis, subacromial decompression, cuff debridement, partial or augmented rotator cuff repair, bursal acromial reconstruction, balloon spacer placement, superior capsular reconstruction, reverse total shoulder arthroplasty, and tendon transfer, among others. Optimally treating the condition relies on paying attention to several patient factors, including correctly identifying whether function loss is driven by pain or compromised shoulder kinematics. If pain is the primary limiting factor, then tuberoplasty, or "reversed subacromial decompression," seems to be a reliable option that can afford encouraging results in terms of pain and range of motion in correctly indicated individuals. It is important to note, however, that these results should not be expected in the patient with anterior-superior humeral escape or pseudoparalysis, in whom a kinematic-restoring option may be more appropriate. Considering a history of inconsistent terminology and definitions when it comes to defining massive tears, when they are irreparable, and when the patient has pseudoparesis versus pseudoparalysis, it is paramount to accurately describe patient factors, including preoperative function, in ongoing research.
巨大的不可修复的肩袖撕裂仍然是一个具有挑战性的问题，有许多报道的治疗选择，包括肱二头肌切断术或肌腱固定术、肩峰下减压术、肩袖清创术、部分或全层肩袖修复术、肩峰下囊重建术、气囊间隔物放置术、肩峰上 capsular 重建术、反式全肩关节置换术和肌腱转移术等。最佳治疗方案取决于关注几个患者因素，包括正确识别功能丧失是由疼痛还是肩部运动学障碍引起的。如果疼痛是主要限制因素，那么结节成形术，或“反向肩峰下减压术”，似乎是一种可靠的选择，可以为正确指示的个体提供在疼痛和运动范围方面令人鼓舞的结果。然而，需要注意的是，对于有前上肱骨逃逸或假性瘫痪的患者，不应期望出现这些结果，对于这些患者，恢复运动学的选择可能更为合适。考虑到在定义巨大撕裂、不可修复以及患者出现假性瘫痪还是假性瘫痪时，术语和定义不一致的历史，准确描述患者因素，包括术前功能，在正在进行的研究中至关重要。
