Massive rotator cuff tears present many technical challenges to the surgeon. Although various techniques have been described for alleviation of pain (cuff debridement) and restoration of function (tendon transfers), mobilization and repair of the transposed cuff, whenever possible, have given more satisfactory results. In massive tears, the rotator cuff tendons retract and adhere to predictable locations and therefore lend themselves to a systematic approach of mobilization and repair. This article describes in detail the indications and preoperative planning; techniques for exposure, mobilization, and repair; potential complications; and rehabilitative considerations involved in the treatment of massive rotator cuff tears.
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