An analysis of failure rates for treatment options for large to massive irreparable rotator cuff tears: a systematic review
Year: 2026
Type: review
Abstract: Background A variety of treatment methods for irreparable rotator cuff tears (RCTs) have been proposed, yet there is no conclusive evidence showing any to be superior. This review aims to use failure rates to compare different treatment methods for irreparable RCTs with the goal of identifying which methods are superior. Methods The studies in this review included patients with large to massive irreparable RCTs and reported failure rates. Seven treatment categories were identified: arthroscopic débridement, subacromial balloon spacer, interposition graft repair, partial repair, reverse total shoulder arthroplasty, superior capsule reconstruction, and tendon transfers. The failure rates for the groups were compiled and compared, as this was the only common outcome measurement between all studies. Results One hundred thirty-six studies consisting of 4,963 shoulders were analyzed. Failure rate, defined as retears, reoperations, or clinical failures as reported, was calculated for each treatment method. The subacromial balloon spacer was found to have the highest failure rate ( P < .001) when compared to the other surgical treatments. The partial repair group ( P ≤ .001) and the interposition graft group ( P ≤ .012) were in the second highest tier. The arthroscopic débridement, reverse total shoulder arthroplasty, superior capsule reconstruction, and tendon transfer groups were in the superior group with similarly low failure rates ( P ≥ .100). Discussion While this review did not identify a single best treatment for irreparable RCTs, it did provide valuable insights into the reliability of different treatments. The results were able to develop a hierarchy based on failure rate, which could help guide treatment for irreparable RCTs.
Authors: Sean P. Cooke, Jason L. Koh, Farid Amirouche
Institutions: University of Illinois Chicago, University of Chicago
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7154332002