Rotator-cuff failure and treatment

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Abstract

Purpose of review

Cuff failure is one of the most common afflictions of the shoulder. Here we synthesize the current information regarding failure of the cuff and its treatment.

Recent findings

Failure of the rotator-cuff attachment arises when tensile loads overwhelm the strength of the enthesis. Atraumatic cuff tears arise insidiously in tendon of compromised quality and present a poor opportunity for durable repair. Acute traumatic tears provide the opportunity for a robust surgical reattachment. Healing of a failed cuff insertion can be accomplished by surgical reattachment of robust tendon to the tuberosity in a manner that excludes joint fluid, provides a smooth upper surface to articulate with the preserved coracoacromial arch, and maintains contact of the tendon edge with prepared bone for the many months required for restoration of the enthesis. This is most dependably achieved by an inlay technique without surgical knots on the bursal aspect of the tendon. In the absence of a durably repairable cuff, attention is directed at relieving stiffness, smoothing the humeroscapular motion interface, and deltoid rehabilitation while preserving the stabilizing effect of the coracoacromial arch.

Summary

This review provides a rationale for current management of rotator-cuff failure.

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