• » Despite an evolving array of surgical options and technologies available to perform rotator cuff repair, as well as advances in postoperative rehabilitation strategies, reported failure rates remain high, with large-to-massive rotator cuff tears showing higher failure rates than small-to-medium-sized tears.
• » Preoperative magnetic resonance imaging is critical for judging the potential repairability of a large-to-massive rotator cuff tear based on imaging characteristics, including tear size and retraction, length and attenuation of the tendon stump, and fatty infiltration or atrophy in the rotator cuff muscle bellies. Advanced fatty infiltration and atrophy in the rotator cuff muscles have been found to be independent predictors of retear following repair of large-to-massive tears.
• » While there is some evidence that double-row rotator cuff repairs have lower failure rates for larger tears, a double-row repair may not always be possible in some chronic, retracted large-to-massive rotator cuff tears that cannot be completely mobilized and have tendon loss.
• » Strategies to augment rotator cuff repairs are based on the desire to improve the mechanical integrity and biologic healing environment of the repair, and they have shown promise in improving healing rates following repair of large-to-massive tears.
• » While most patients report pain relief and have increased patient-reported outcomes scores after surgery, studies have shown that patients with an intact repair have better functional scores, range of motion, and strength, and less fatty degeneration compared with patients with a failed repair.

中文翻译：

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可修复的大到大转子肩袖撕裂的外科治疗更新。

• »尽管用于执行肩袖修复的外科手术方法和技术不断发展，并且术后康复策略有所进步，但报告的失败率仍然很高，大到大规模的肩袖撕裂显示出更高的失败率。中型的眼泪。
• »术前磁共振成像对于根据成像特征（包括眼泪大小和缩回，肌腱残端的长度和衰减以及肩袖中的脂肪浸润或萎缩）的影像学特征来判断大型至大型肩袖撕裂的潜在可修复性至关重要肌肉肚子。已发现肩袖肌肉中的晚期脂肪浸润和萎缩是修复大眼泪后眼泪的独立预测因子。
• »虽然有证据表明，双排肩袖修补术对较大的眼泪有较低的失效率，但对于某些无法完全动员的慢性，缩回大到大的肩袖撕裂，并非总是能够进行双排修补肌腱脱落。
• »增强肩袖修复的策略是基于改善修复的机械完整性和生物修复环境的愿望，并且已显示出在修复大面积到大批量眼泪后提高治愈率的希望。
• »虽然大多数患者在手术后均能缓解疼痛并报告了更高的患者预后评分，但研究表明，与修复失败的患者相比，修复完整的患者具有更好的功能评分，运动范围和力量，脂肪变性更少。