Tag Archive for: Massive irreparable rotator cuff tears

Volume 6 | Issue 1 | January-June 2021 | Page 31-35 | Ram Chidambaram, Reet Mukhopadhyay

Author: Ram Chidambaram [1], Reet Mukhopadhyay [2]

[1] Department of Shoulder, Elbow, Hand and Sports Injuries, MGM Healthcare, Aminjikarai, Chennai, Tamil Nadu, India.
[2] Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.

Address of Correspondence:
Dr. Reet Mukhopadhyay,
Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.
E-mail: reetm.2008@gmail.com


Rotator cuff pathology is one of the most common conditions affecting the shoulder joint. Several classification systems have been used to describe rotator cuff tears in orthopedic literature. However, no comprehensive classification inclusive of all types and characteristics currently exists. Rotator cuff tears are classified based on various parameters. These include: 1. Tear depth 2. Tear Size/Extent 3. Tear Retraction 4. Tendon Quality 5. Tear Progression 6. Arthroscopic Classification. This review article aims to establish an algorithm based on the various existing classification systems so as to arrive at the best surgical or non-surgical solution as well as prognosticate the patient regarding the outcome. Special consideration needs to be made for massive tears which are irreparable.
Keywords: Rotator cuff tears; Rotator cuff tear classification; Massive irreparable rotator cuff tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.


1. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64–74.

2. Davidson J, Burkhart SS. The Geometric Classification of Rotator Cuff Tears: A System Linking Tear Pattern to Treatment and Prognosis. Arthrosc – J Arthrosc Relat Surg [Internet]. 2010;26(3):417–24. Available from: http://dx.doi.org/10.1016/j.arthro.2009.07.009.

3. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;(254):81–6.

4. Collin P, Matsumura N, Lädermann A, Denard PJ, Walch G. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elb Surg. 2014;23(8):1195–202.

5. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Jt Surg – Ser A. 2007;89(6):1184–93.

6. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78–83.

7. Fuchs B, Weishaupt D, Gerber C, Hodler J. Scheduled Tomography for. :599–605.

8. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol. 1998;33(3):163–70.

9. Thomazeau H, Rolland Y, Lucas C, Duval J, Langlais F. Atrophy of the supraspinatus belly. Acta Orthop. 1996;67(3):264–8.

10. Brolin TJ, Updegrove GF, Horneff JG. Classifications in Brief: Hamada Classification of Massive Rotator Cuff Tears. Clin Orthop Relat Res. 2017;475(11):2819–23.

11. Spencer EE, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008;36(1):99–103.

12. Habermeyer P, Magosch P, Lichtenberg S. Classifications and scores of the shoulder. Classifications and Scores of the Shoulder. 2006. 1–297.

13. Lädermann A, Burkhart SS, Hoffmeyer P, Neyton L, Collin P, Yates E, et al. Classification of full-thickness rotator cuff lesions: A review. EFORT Open Rev. 2016;1(12):420–30.

14. Brolin TJ, Updegrove GF, Horneff JG. Classifications in Brief: Hamada Classification of Massive Rotator Cuff Tears. Clin Orthop Relat Res. 2017;475(11):2819–23.

15. Juhan T, Stone M, Jalali O, Curtis W, Prodromo J, Weber AE, et al. Irreparable rotator cuff tears: Current treatment options. Orthop Rev (Pavia). 2019;11(3):123–8.

16. Neri BR, Chan KW, Kwon YW. Management of massive and irreparable rotator cuff tears. J Shoulder Elb Surg [Internet]. 2009;18(5):808–18. Available from: http://dx.doi.org/10.1016/j.jse.2009.03.013.

17. Oh JH, Park MS, Rhee SM. Treatment strategy for irreparable rotator cuff tears. CiOS Clin Orthop Surg. 2018;10(2):119–34.

18. DeOrio JK, Cofield RH: Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 1984;66(4):563-567.

19. Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg 2014;23:1023-1027.

20. Neer CS 2nd, Cruess RL, Sledge CS, Wilde AH. Total glenohumeral replacement: a preliminary report. Orthop Trans. 1977;1:244–245.

21. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res. 1990;254:92–96.

22. Walch G, Edwards B, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14:238–246.

23. Burkhart SS: Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears: A suspension bridge model. Clin Orthop Relat Res 1992;284:144-152.

24. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg [Am] 2000;82-A:505-515.

25. Neviaser TJ, Neviaser RJ, Neviaser JS, Neviaser JS. The four-in-one arthroplasty for the painful arc syndrome. Clin Orthop Relat Res. 1982;(163):107-112.

26. APA Nho, Shane J. MD, MS; Strauss, Eric J. MD; Lenart, Brett A. MD; Provencher, Matthew T. MD, MC, USN; Mazzocca, Augustus D. MD, MS; Verma, Nikhil N. MD; Romeo, Anthony A. MD Long Head of the Biceps Tendinopathy: Diagnosis and Management, American Academy of Orthopaedic Surgeon: November 2010 – Volume 18 – Issue 11 – p 645-656.

27. Pedowitz RA, Higashigawa K, Nguyen V: The “50% rule” in arthroscopic and orthopaedic surgery. Arthroscopy 2011;27 (11):1584-1587.

How to Cite this article: Chidambaram R, Mukhopadhyay R | Classification Systems in Rotator Cuff Tears | Asian Journal of Arthroscopy | January- June 2021; 6(1): 31-35.

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