Surgical Management of Irreparable Rotator Cuff Tears: A Survey of Current Practice and Literature Review.

Introduction Irreparable rotator cuff tears (RCTs) are a complex challenge encountered by shoulder surgeons. Despite a range of repair strategies, the preferences and indications of these remain unclear. Our study aims to identify current practices, preference for graft choice and indications for capsular reconstruction amongst UK-based surgeons. Methods An online survey was sent to members of the British Elbow and Shoulder Society (BESS). Procedural preferences, operative frequency, indications/contra-indications for superior capsular reconstruction (SCR) and graft choice were ascertained. An independent t-test was used to determine statistical significance. Results One hundred and ten upper limb surgeons responded to the survey. Of this cohort, 90/110 (81.8%) would be able to perform a partial cuff repair, 89/110 (80.9%) could offer a reverse shoulder arthroplasty (RSA) and 82/110 (74.6%) could perform debridement only. Less commonly, 35/110 (31.8%) could offer an Inspace balloon device, 31/110 (28.2%) SCR and 16/110 (14.6%) a tendon transfer. None of the respondents had performed more than 10 Inspace balloons in the previous year. 72/105 (68.6%) had never performed a SCR and 86/105 (82%) had never performed a tendon transfer. Over 58/105 (55.2%) had performed >10 RSA in the previous year. The graft of choice for SCR was human dermal allograft 33/100 (33%) and this choice was most frequently guided by surgeon preference. Conclusion Our study demonstrates that various treatment options can be offered for the management of irreparable RCTs. The commonest procedure offered is a partial cuff repair followed by RSA. Newer, novel procedures such as Inspace balloon and tendon transfers are less commonly offered in UK-based practices and their indications for use are less well defined. Future high-powered, multi-centre studies are required to identify the role and outcomes of these procedures.