This book offers a truly comprehensive overview of the understanding and treatment of massive and irreparable rotator cuff tears, a painful and disabling shoulder condition that continues to pose major challenges. A thorough examination of basic science issues and evidence lays the foundation for discussion of key controversies in the field and exposition of a practical approach to treatment in which the role of both conservative and surgical management is explained. Special insights are provided into the new biological and nonoperative approaches that are becoming increasingly popular among practitioners. All potential surgical techniques are described, from partial repair and tendon transfer, to the use of dedicated implants. In addition, the value of anesthesia and regional blocks, both during surgery and in the postoperative phase, is discussed. The concluding section addresses particularly complex scenarios and offers guidance on the management of treatment complications and failures. Written by leading international shoulder experts, the book will be of value for shoulder surgeons, rehabilitators, and other health care practitioners.

Part 1 Basic science.- Massive and irreparable rotator cuff tears: defining the problem.- Biology of rotator cuff injury and repair.- Biomechanics of rotator cuff repair.- Re-rupture or non-healing? Factors determining an unsuccessful repair.- Biological augmentation in rotator cuff repair: growth factors.- Biological augmentation in rotator cuff repair: cell therapies.- Biological augmentation in rotator cuff repair: scaffolds.- Imaging of repaired rotator cuff.- Part 2 Controversies in massive rotator cuff tears.- Clinical outcome vs structural integrity: what really matters?.- Fatty infiltration and muscle atrophy: what it means and what happens after repair.- Pseudoparalysis: Pathomechanics and clinical relevance.- Rotator cuff tear arthropathy: where are the limits for repair?.- Suprascapular nerve release: fact or fiction.- Traumatic cuff tears: the relevance of timing.- Critical shoulder angle: doeslateral acromioplasty have a role in preventing re-rupture

Shoulder injections: options, ultrasound assistance, evidences.- Non-operative Treatment: The Role of Rehabilitation.- Patient Expectation in the treatment of rotator cuff tears: what is it's role?.- Treatment of massive irreparable cuff tears: decision-making process.- Part 3 Surgical techniques.- Partial repair.- Patch Graft Augmentation.- Superior capsule reconstruction.- Postero-superior Massive Irreparable Rotator Cuff Tears: The Biceps Autograft.- Tendon Transfer for Posterosuperior Cuff: Latissimus Dorsi Transfer
Tendon Transfer for Posterosuperior Cuff.- Tendon Transfer for Posterosuperior Cuff: Latissimus Dorsi Transfer.- Tendon transfer for anterosuperior cuff: The Pectoralis Major Transfer.- Tendon transfer for anterosuperior cuff: Latissimus Dorsi Transfer.- Subacromial spacer.- Regional blocks and opioid sparing anesthesia: helping the surgeon and with patients' satisfaction.- Part 4 Complex and revision problems.- Traumatic rotator cuff tears with shoulder stiffness.- Management of bone loss in rotator cuff tear arthropathy.- Work-up and management of infection in shoulder arthroplasty.- Biomechanics of failure of reverse shoulder arthroplasty in rotator cuff tear arthropathy.- Revision of reverse total shoulder arthroplasty: humeral component.- Failure of Rotator Cuff Repair.- Combined massive rotator cuff and recurrent shoulder instability.- "Reverse arthroplasty VS other options" - Cases examples.- Case example 4: Massive rotator cuff tear and patient specific rehabilitation in sportsmen.