Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options

center dot While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function. center dot Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure. center dot In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used. center dot However, several innovative arthroscopic treatment options have also been developed. center dot The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results. center dot Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers.