Tendon transfers for irreparable rotator cuff tears.

Symptomatic irreparable rotator cuff tears pose a challenge for shoulder surgeons. Whilst reverse polarity shoulder arthroplasty is an effective option for older symptomatic patients who have exhausted conservative management, the optimal treatment for younger patients remains controversial. In this article we outline the main tendon transfer options, including anatomical considerations, indications, contraindications, surgical technique, complications and a review of the evidence. Tendon transfers provide an alternative joint-preserving surgical option, but the evidence so far is limited, with a clear need for well-designed comparative studies to confirm their effectiveness.

Management of rotator cuff tears - Key historical landmarks.

The management of rotator cuff pathology has developed over hundreds of years. In this article, we take a journey from the early days, in order to understand how we have reached our modern-day practice. Initially our understanding of rotator cuff pathology was based on cadaveric anatomical findings and this has enhanced over the years by the development of radiological and surgical techniques. We discuss the historical debates over the pathogenesis of cuff dysfunction. This work describes the landmark publications by several clinicians who have made important contributions to our understanding of rotator cuff pathology and its management. We follow the trends of surgical management of rotator cuff tears, traditionally performed via an open technique, to an exponential rise in arthroscopic surgery in recent years. As new techniques emerge, a review of the historical rise and fall of techniques is a reminder for us to remain vigilant of surgical indications and rigorous outcome analysis.