International Orthopaedics

, Volume 39, Issue 12, pp 2403–2414 | Cite as

Massive rotator cuff tears: definition and treatment

  • Alexandre LädermannEmail author
  • Patrick J. Denard
  • Philippe Collin
Original Paper



The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT.


Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT.


Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis.


There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series.


Shoulder function Massive rotator cuff repair Cuff tear arthropathy Scores Tendon transfer Arthroscopy Pseudoparalysis Reverse shoulder arthroplasty Outcome 



One author of this study (PC) is a paid consultant from Tornier and Smith and Nephew and received royalties from Tornier, Storz and Advanced Medical Application. Another author (PJD) is a paid consultant for Arthrex.

Ethical committee approval



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Copyright information

© SICOT aisbl 2015

Authors and Affiliations

  • Alexandre Lädermann
    • 1
    • 2
    • 3
    Email author
  • Patrick J. Denard
    • 4
    • 5
  • Philippe Collin
    • 6
  1. 1.Division of Orthopaedics and Trauma SurgeryLa Tour HospitalMeyrinSwitzerland
  2. 2.Faculty of MedicineUniversity of GenevaGeneva 4Switzerland
  3. 3.Division of Orthopaedics and Trauma Surgery, Department of SurgeryGeneva University HospitalsGeneva 14Switzerland
  4. 4.Southern Oregon OrthopedicsMedfordUSA
  5. 5.Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandUSA
  6. 6.Saint-Grégoire Private Hospital CenterSaint-Grégoire CedexFrance

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