Treating massive, non-repairable rotator cuff tears presents significant challenges due to the complexity of the condition. These tears often require advanced and specialized surgical techniques to achieve the best outcomes. Here, we explore the innovative treatment options available and the importance of selecting the appropriate procedure, performed by a highly skilled specialist. As a Shoulder and Elbow specialist I frequently get referred revision rotator cuff repairs and massive rotator cuff tears that are irreparable. 3 of the most common procedures that I perform are:
Rotator Cuff Repair with Biologic Augmentation: This procedure involves using biological materials, such as grafts or patches, to enhance the repair of the torn rotator cuff. These materials promote healing and provide additional support to the repaired tissue, improving the overall strength and function of the shoulder. These procedures are performed completely arthroscopically without the need for an open incision.
Figure 1: A massive 2 tendon rotator cuff tear with 4 cm of retraction 
Figure 2: Rotator Cuff repaired with Double Row Technique 
Figure 3: After repair, it is augmented with a Bioinductive Healing Implant 
Arthroscopically Assisted Lower Trapezius Tendon Transfer: In cases where the rotator cuff cannot be repaired directly, the lower trapezius tendon transfer offers an effective alternative. This procedure involves re-routing the lower trapezius muscle to replace the function of the damaged rotator cuff. The use of arthroscopy ensures minimal invasiveness, reducing recovery time and enhancing surgical precision. The lower trapezius tendon is lengthened with an allograft tendon and can help restore function, alleviate pain , and improve strength. This procedure is arthroscopically assisted and has a mini-open incision on the posterior shoulder.
Figure 4 Left shoulder with massive rotator cuff tear, non repairable 
Figure 5 The Achilles allograft is attached to the Greater tuberosity with a double row anchor construct 
Figure 6 Lower trapezius tendon on a left shoulder prior to graft attachment through a 5 cm incision on the posterior shoulder blade 
Figure 7 Lower trapezius woven to allograft completing the transfer 
Biologic Tuberoplasty: Biologic tuberoplasty involves the application of human dermal allograft to the greater tuberosity of the humerus, where the rotator cuff tendons attach. This technique aims to create an “spacer” between the humerus and the acromion to prevent bone on bone contact. It is particularly beneficial in cases where traditional repair methods are not feasible and has high functional demands that would preclude a shoulder replacement.
Figure 8: This is a large retracted rotator cuff tear, non repairable. The joint is well preserved and the patient had normal overhead motion. 
Figure 9: Biologic Tuberoplasty performed with Human Dermal Allograft 
Why choose Dr. Acevedo?
The success of treating massive rotator cuff tears heavily relies on selecting the most suitable procedure for each individual case. Each treatment option has its unique benefits and indications, making the decision-making process critical. Moreover, the technical prowess required to perform these advanced procedures cannot be overstated. A skilled surgeon must possess extensive training and experience to navigate the complexities of these treatments and achieve optimal results.
Dr. Acevedo is a distinguished shoulder and elbow specialist with extensive training in these cutting-edge techniques. His expertise in shared decision-making ensures that each patient receives a tailored treatment plan designed to meet their specific needs. With a commitment to excellence and a deep understanding of the intricacies involved in treating massive rotator cuff tears, Dr. Acevedo is dedicated to helping you achieve the best possible outcome. Additionally, Dr. Acevedo shares his knowledge and expertise by teaching courses nationally on these advanced treatments, further highlighting his proficiency and leadership in the field.
