It is through several mechanisms that torn rotator cuff tendons get to a stage of being irreparable. An irreparable tear is not the same as a massive tear though it is often confused with each other. The key difference is that an irreparable rotator cuff tear can be massive but all massive tears aren’t necessarily irreparable. In the case of irreparable tears, the tendon tissue will first become weak and thin and easily torn when repair is attempted and following this stage atrophy sets in the muscle to which the tendon is attached.

The muscle ultimately turns fibrotic and infiltrated with fat, making joint movement excruciatingly tougher. Based on their size, retraction, and muscle impairment caused by atrophy and fatty infiltration, the lesions will then be categorized as irreparable. Like everywhere else in our body, muscles and tendons need to work against resistance to maintain strength and form. The muscles and tendons atrophy when this resistance is lacking. This will consequently make the tendon get thinner and weaker and shorter even thereby enlarging the tear even further.

The muscle ultimately turns fibrotic and infiltrated with fat, making joint movement excruciatingly tougher. Based on their size, retraction, and muscle impairment caused by atrophy and fatty infiltration, the lesions will then be categorized as irreparable. Like everywhere else in our body, muscles and tendons need to work against resistance to maintain strength and form. The muscles and tendons atrophy when this resistance is lacking. This will consequently make the tendon get thinner and weaker and shorter even thereby enlarging the tear even further.
In an irreparable rotator cuff tear, the enlarged tear often involves multiple tendons that are of poor quality and quantity. These tendons are in turn attached to muscles that are weakened, atrophied, shortened and scarred. That’s not it, there can also be certain bony changes that begin to develop in the shoulder joint as a result of everything else. So, this all about the basic mechanism behind an irreparable tear.
Irreparable tears are something that can happen over time owing to microtrauma and intrinsic changes to the tendon. The tendon’s ability to heal damage is then impeded due to the inadequate blood supply or other age-related biologic impairments. The damage done then further accumulates with age and time, until the tendon begins to fall off the bone and is deemed irreparable.
As for the treatment of irreparable rotator cuff tears, it all comes down to the patient functional status and skill of the surgeon. Depending on patient factors like age, activity, and the quality of the rotator cuff tendon the ideal treatment strategy chosen can vary. For low demand patients with minimal pain, while debridement, partial-repair, and subacromial decompression with or without biceps tenodesis versus tenotomy, non-operative treatment options are generally recommended.
Tendon transfer of the lower trapezius tendon has become more recently popularized for treating irreparable rotator cuff tears. Tendon transfers including the latissimus dorsi, pectoralis major, and trapezius muscles have been used to improve function. Another treatment option is when scaffold devices have been used as a biologic patch graft and augment.
A novel technique to restore glenohumeral stability could be the superior capsule reconstruction. Reverse total shoulder arthroplasty and hemiarthroplasty can be used as salvage options in patients with rotator cuff tear arthropathy suffering from continued pain and decreased function. Another promising surgical treatment option to help treat irreparable rotator cuff tears could be the Dermal allograft augmentation but research with regard to this is still underway.

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