Arthroscopic treatment of massive rotator cuff tears

In the past 10 years, arthroscopic surgeons have gone from being unable to repair any rotator cuff tears arthroscopically to being able to repair virt ually all rotator cuff tears, even complex massive tears, arthroscopically. The factors responsible for this rapid evolution have been: (1) recognitio n of the mechanical principles responsible for a secure repair (margin conv ergence, knot security, loop security); (2) recognition of major tear patte rns that require different techniques of repair; and (3) development of ins trumentation and arthroscopic portals that predictably accomplish secure re pair of the rotator cuff and direct access to the pathologic areas. In the current study, the author analyzes each factor, anatomic and mechanical, th at influences the quality of the repair, and explains how to optimize the o verall repair by optimizing each step in the repair. In the author's series of arthroscopic repair of rotator cuff tears, the results have been gratif ying, with massive tears achieving final results equivalent to those of sma ller tears.