Is the Nomenclature of Massive Rotator Cuff Tear Used Correctly? Systematic Review

Vol 8 | Issue 1 | January-June 2022 | page: 06-10 | Alper Deveci, Hakan Dur, Erkan Alkan

DOI: 10.13107/ti.2022.v08i01.022

Authors: Alper Deveci [1], Hakan Dur [1], Erkan Alkan [1]

[1] Department of Orthopaedics and Traumatology, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey.

Address of Correspondence

Dr. Alper Deveci,
Department of Orthopaedics and Traumatology, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey.


Background:  The term massive refers to a quantitative measure of the rotator cuff tears. Irreparable rotator cuff tear is indicated by ratings that qualitatively evaluate the repairability of the tendon. These two terms should be considered separately.

Methods: Between 2016 and 2022, publications in the last about 5 years were searched from Pubmed and MEDLINE online databases. The search terms (irreparable OR massive) AND (rotator cuff tear), (repairable OR massive) AND (rotator cuff tear), (massive OR retracted) AND (rotator cuff tear), (irreparable OR retracted) AND (rotator cuff tear) ”were used. For each search term, it was checked whether the title of the search term was mentioned in the title of the article, and whether the title and the content were compatible in the studies in which the searched term was mentioned in the title.

Results: Of the 934 scanned articles, 69 of them were evaluated in terms of study title and material-method compatibility. 22 articles with the term “massive rotator cuff tear” in the title were identified. It was seen that in 11 of these 22 articles (50%), the title and the material method were compatible and in 11 of them (50%) the title and the content were incompatible, and the term “massive” was used instead of the term “irreparable”.

Conclusions: We see that most of the studies on massive tears were actually done to emphasize irreparable tears. Since most of the massive tears are repairable, the quality feature of massive tears, which are in the group that poses a problem, as irreparable rotator cuff tear or massive irreparable rotator cuff tear should be emphasized.

Keywords: Rotator cuff tears, Shoulder, Arthroscopy, Ireparable, Massive


1. Greenspoon JA, Petri M, Warth RJ, Millett PJ. Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes. J Shoulder Elbow Surg 2015;24(9):1493- 1505. https://doi: 10.1016/j.jse.2015.04.005

2. Henry P, Wasserstein D, Park S, Dwyer T, Chahal J, Slobogean G, Schemitsch E. Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review. E.Arthroscopy 2015;31(12):2472-80. https://doi: 10.1016/j.arthro.2015.06.038

3. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 1984;66(4):563–7. 00011

4. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000;82(4):505–15.

5. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;304:78–83.

6. Burks RT, Tashjian RZ. Should we have a better definition of pseudoparalysis in patients with rotator cuff tears? Arthroscopy 2017;33: 2281–3.

7. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599-605.

8. Omid R, Lee B. Tendon transfers for irreparable rotator cuff tears. A Am Acad Orthop Surg 2013;21:492-501.

9. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res 1990;254:81-6

10. Williams MD, Lädermann A, Melis B, Barthelemy R, Walch G. Fatty infiltration of the supraspinatus: a reliability study. J Shoulder Elbow Surg 2009;18:581–7. https://doi:10.1016/j.jse.2008.12.014 28

11. Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg 2014;23:1023–7. https://doi:10.1016/j. jse.2014.02.014

12. Kim SJ, Kim SH, Lee SK, Seo JW, Chun YM. Arthroscopic repair of massive contracted rotator cuff tears: Aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am 2013;95:1482-8.

13. Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with lowgrade fatty degeneration of the infraspinatus: Patch autograft procedure versus partial repair procedure. Arthroscopy 2013;29:1911-21.

14. Novi M, Kumar A, Paladini P, Porcellini G, Merolla G. Irreparable rotator cuf tears: challenges and solutions. Orthop Res Rev 2018;10:93–100.

15. Burkhart SS, Denard PJ, Konicek J, Hanypsiak BT. Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears. Am J Sports Med 2014;42: 457–2. https://doi:10.1177/0363546513516602

16. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy 2004;20: 22–33. https://doi:10.1016/j.arthro.2003.11.013

17. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg 2010;8:336-341.

18. Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta P III, Bhandari M. Level of evidence in ortho- paedic journals. J Bone Joint Surg Am 2005;87:2632-2638.

19. Collin P, Matsumura N, Lädermann A, Denard PJ, Walch G. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg 2014; 23(8):1195–1202. https://doi:10.1016/j.jse.2013.11.019

20. Dwyer T, Razmjou H, Henry P, Gosselin-Fournier S, Holtby R. Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2015;23:415-22.

21. Karuppaiah K, Sinha J. Scaffolds in the management of massive rotator cuff tears: current concepts and literature review. EFORT Open Rev 2019; 4:557-566. doi: 10.1302/2058-5241.4.180040

22. Cowling P, Hackney R, Dube B, Grainger AJ, Biglands JD, Stanley M, Song D, Conaghan PG, Kingsbury SR. The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study. BMC Musculoskelet Disord 2020 ;21:213. doi: 10.1186/s12891-020-03227-z.

23. Duchman KR, Mickelson DT, Little BA, Hash TW, Lemmex DB, Toth AP, Garrigues GE. Graft use in the treatment of large and massive rotator cuff tears: an overview of techniques and modes of failure with MRI correlation. Skeletal Radiol 2019; 48:47-55. doi: 10.1007/s00256-018-3015-4.

24. Lin J, Sun Y, Chen Q, Liu S, Ding Z, Chen J. Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review. Am J Sports Med 2020; 48:2828-2838. doi: 10.1177/0363546519889040.

25. Malahias MA, Chytas D, Kostretzis L, Gkiatas I, Kokkineli S, Antonogiannakis E. Arthroscopic anatomic complete versus non-anatomic repair of massive rotator cuff tears: a systematic review of comparative trials. Musculoskelet Surg 2020; 104:145-154. doi: 10.1007/s12306-020-00648-w.

26. Memon M, Kay J, Quick E, Simunovic N, Duong A, Henry P, Ayeni OR. Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive Rotator Cuff Tears: A Systematic Review. Orthop J Sports Med. 2018; 6:2325967118777735. doi:10.1177/2325967118777735.

27. Ono Y, Herrera DAD, Woodmass JM, Boorman RS, Thornton GM, Lo IKY. Graft Augmentation Versus Bridging for Large to Massive Rotator Cuff Tears: A Systematic Review. Arthroscopy 2017; 33:673-680. doi:10.1016/j.arthro.2016.08.030.

28. Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Superior Capsular Reconstruction for Massive Rotator Cuff Tear Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy 2019; 35:1269-77. doi: 10.1016/j.arthro.2018.10.129.

29. Villatte G, Erivan R, Nourissat G, Marcheix PS, Pereira B, Aubret S, Boisgard S, Descamps S. Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2039-59. doi:10.1007/s00167-021-06745-y.

30. Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE. Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg. 2018; 102:247-255. doi: 10.1007/s12306-017-0525-5.

How to Cite this article: Deveci A, Dur H, Alkan E | Is the Nomenclature of Massive Rotator Cuff Tear Used Correctly? Systematic Review | January-June 2022; 8(1): 06-10.


(Abstract Text HTML)   (Download PDF)