Irreparable Rotator Cuff Tears

The determination that a rotator cuff tear is irreparable is complicated and its management is equally as complex, with numerous surgical techniques described in the literature. This chapter reviews the clinical and radiographic risk factors that predict an irreparable tear and the approach to assessing each patient. Various joint-preserving procedures have been described and include arthroscopic debridement, biceps surgery, balloon spacer implantation, graft interposition, superior capsular reconstruction, and tendon transfers. The evidence for each option is presented to assist in clinical decision-making and an algorithm is provided based on the preferred treatment of the authors.