Guadagno Kaitlyn, Srikumaran Uma, Huish Eric G, Best Matthew J
Department of Orthopaedic Surgery, San Joaquin General Hospital, French Camp, CA, USA.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Ann Jt. 2023 Aug 21;8:38. doi: 10.21037/aoj-23-7. eCollection 2023.
The management of massive rotator cuff tears (MRCT) presents a unique challenge to many orthopedic specialists. Unlike tears that are predicted to do well with primary, complete repair, MRCT are affected by tissue retraction, in-elasticity, bursal scarring, muscle atrophy, and fatty degeneration; operative repair thus portends worse healing rates than smaller tears and is associated with recurrent tear rates of up to 91% based on ultrasonography and magnetic resonance imaging (MRI). Rotator cuff tears are a common condition in patients over the age of 50. Thus, multiple advances in treatment strategies have been made to combat the limited efficacy of complete or partial rotator cuff repair in the setting of a massive or irreparable rotator cuff tears. It is of utmost importance that the operating orthopedic surgeon be familiar with these various treatment modalities to best serve the patient and that they harbor these skills within their armamentarium. This article details a review of the current literature including nonoperative and operative treatments for the management of massive and irreparable rotator cuff tears. The primary objective is to propose a literature-based algorithm for the treatment of massive and often irreparable rotator cuff tears to allow for informed ease in the decision-making process.
巨大肩袖撕裂（MRCT）的治疗给许多骨科专家带来了独特的挑战。与预计能通过一期完全修复取得良好效果的撕裂不同，MRCT 会受到组织回缩、弹性丧失、滑囊瘢痕形成、肌肉萎缩和脂肪变性的影响；因此，手术修复的愈合率比小撕裂更差，根据超声检查和磁共振成像（MRI），其复发撕裂率高达91%。肩袖撕裂在50岁以上的患者中很常见。因此，为了应对在巨大或无法修复的肩袖撕裂情况下完全或部分肩袖修复疗效有限的问题，治疗策略已经取得了多项进展。至关重要的是，主刀骨科医生要熟悉这些各种治疗方式，以便为患者提供最佳服务，并且他们要在自己的医疗技能库中掌握这些技能。本文详细回顾了当前文献，包括针对巨大和无法修复的肩袖撕裂治疗的非手术和手术治疗方法。主要目的是提出一种基于文献的算法，用于治疗巨大且通常无法修复的肩袖撕裂，以便在决策过程中能轻松做出明智的决定。
