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Management of Massive Irreparable Rotator Cuff Tears: Muscle Transfer Techniques for Augmentation
Massive irreparable rotator cuff tears (RCTs) can lead to substantial loss of range of motion (ROM) and variable degrees of pain. The loss of the centering force of the rotator cuff results in eccentric loading of the glenoid. Abnormal wear patterns may develop, which can lead to arthritic changes in the shoulder. An anterosuperior RCT usually involves the subscapularis with or without the supraspinatus. With the loss of the subscapularis, the shoulder anterior force couple is lost. With larger tears, the proximal humerus may protrude anterosuperiorly through the anterior cuff defect. The aim of the muscle transfer procedure is to restore the joint mechanics by restoring the force couple across the joint.