When to Fix a Cuff Tear: Surgical Indications

Introduction

A rotator cuff tear (RCT) is a commonly encountered diagnosis that, when symptomatic, can be treated operatively or nonoperatively. Often, it can be an incidental finding on imaging that necessitates no specific management. However, patients are often symptomatic and will require some form of treatment. The majority of patients with an atraumatic RCT will have improved pain and functional scores with a nonoperative treatment regimen. There are patients, however, who are indicated for an acute repair while others may be candidates for surgery if they fail nonoperative treatment or have concomitant injuries that require urgent operative treatment. Rotator cuff repair (RCR), whether performed in an open or an arthroscopic manner, is a widely performed procedure with successful results for the majority of patients, although complications can occur. Proper identification of the patients who should and should not be selected for surgical repair is paramount to obtaining positive results postoperatively.

Clinical Description

Effective treatment of rotator cuff pathology requires an in-depth understanding of the indications for surgical treatment. As shown by Yamaguchi and others, RCTs occur as a natural consequence of aging and as such are frequently asymptomatic and require no treatment. While degenerative/chronic tears of the supraspinatus in older individuals are normal and not necessarily symptomatic, tears of other tendons, particularly those in combination with the supraspinatus, are a frequent source of debilitating pain and dysfunction and require surgical treatment to relieve pain and restore function, particularly in younger patients and those with traumatically induced lesions.

Although there are not many absolute indications for RCR, several general principles should be considered as part of the clinical and shared decision-making for determining optimal treatment. These basic principles are introduced and explored in depth in this chapter.