Open techniques for repair of largeand massive rotator cuff tears

Rotator cuff tears can be a significant source of shoulder pain and weakness. Repair of full-thickness tears canimprove patient satisfaction and functional outcome. Several repair techniques have been described in the literature; these include arthroscopic and open approaches. Although arthroscopic repair has been popularized in the recent literature, it may not be optimal for some cases of large or massive rotator cuff tears. Open approaches allow greater access for mobilization and enable placement of bone tunnels for bone-tendon repair. The surgeon may readily release bursal and articular sided adhesions and mobilize the retracted tendon to its anatomic footprint on the greater tuberosity. This article describes 2 surgical approaches of open repair, the mini-open and formal open approach. Furthermore, useful techniques for tendon mobilization, bone-tendon repair, and postoperative rehabilitation for the management of large and massive rotator cuff tears are described.