Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts

BACKGROUND: While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient. PURPOSE: To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs. STUDY DESIGN: Narrative review. METHODS: A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included. RESULTS: Recent literature reflects added attention to clarifying the definitions of “massive, “irreparable,” and “pseudoparalysis.” In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them. CONCLUSION: The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.