Partial cuff debridement for irreparable defects of the rotator cuff

The treatment of massive rotator cuff tears can pose a difficult problem for the unprepared orthopaedic surgeon.There are many ways to treat massive rotator cuff tears, and one viable option is debridement with acromioplasty. For this form of treatment to be successful, the surgeon must choose his patient carefully. This report will focus on patient selection, biomechanics, and postoperative rehabilitation. A thorough understanding of rotator cuff tear biomechanics is needed when treating a massive tear; thorough physical and radiological examinations will help the orthopedist understand the biomechanic characteristic of the patient's tear. A tear that is balanced in both the transverse and coronal planes is stable and functional and will do well with debridement. Conversely, a tear that is unbalanced in either the transverse or coronal planes is unstable and nonfunctional and will not do well with simple debridement. Nonfunctional tears demand an attempt at rotator cuff tendon repair to restore balance to the cuff, making the tear functional. Debridement of a functional tear can be successfully performed with arthroscopic or open technique. Preservation or reconstruction of the coracoacromial (CA) arch is important because it adds anterosuperior stability to the shoulder with a massive rotator cuff tear. Postoperative rehabilitation is as important as the surgery itself and will also be emphasized. Many surgeons have had success with debridement of massive rotator cuff tears; however, as with any procedure, proper understanding of the pathology and proper patient selection is paramount to obtaining a successful result.