Surgical Options for Massive Rotator Cuff Tears with Preserved Full Range of Motion in Middle-Aged Patients

Rotator cuff tears (RCTs) are a major cause of shoulder pain and dysfunction, leading to increasing numbers of outpatient visits and surgical interventions.Their preva-lence in the general population ranges from 20.7% to 22.1%, with large-to-massive tears accounting for approximately 10% to 40%. [1][2][3] Arthroscopic repair has become the standard treatment for RCTs, particularly small-to-medium lesions.However, massive rotator cuff tears (MRCTs) remain challenging due to poor tendon quality, scarring, muscle atrophy, fatty infiltration, and limited vascularity, all of which contribute to high failure rates and impaired healing. [3][4][5][6][7][8][9][10][11][12][13][14][15] In middle-aged patients with preserved range of motion and minimal glenohumeral arthritis, reverse total shoulder arthroplasty may be inappropriate.Accordingly, numerous surgical approaches have emerged to maintain shoulder joint integrity and improve clinical outcomes in patients with MRCT. 5,9)his review provides a comprehensive overview of current surgical options for MRCTs in middle-aged patients.In this review, middle-aged patients are defined as individuals between 45 and 64 years of age, in accordance with commonly accepted classifications in orthopedic