Surgical treatment of massive rotator cuff tears (literature review)

Abstract

The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.