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The Massive Rotator Cuff Tear: Patches and Augmentation Devices
Treatment of massive rotator cuff tears can be a challenge. Failure rates significantly exceed those for smaller tears. Chronic tears can be especially challenging because the bone and soft tissues change over time. Without mechanical stress, the tendons, which have minimal blood flow to begin with, degenerate further and become friable. The muscles lose volume and undergo fatty replacement. The greater tuberosity loses density, making anchor retention more difficult. Without a superior restraint, the deltoid pulls the humeral head into the acromion, and the inferior capsule becomes contracted and stiff. The articular cartilage begins to degrade and arthropathy develops.