large/massive tears, fatty infiltration, and rotator cuff muscle atrophy: a review article with management options specific to these types of cuff deficiencies

Context: there are many studies in the literature looking into factors affecting outcomes in rotator cuff surgery. the aetiology of rotator cuff deficiency is often multi-factorial and there are many facets towards successful management in this often debilitating condition. evidence acquisition: we performed a literature search of medline and embase databases using the terms large rotator cuff tears, fatty infiltration rotator cuff, rotator cuff atrophy, rotator cuff augmentation, rotator cuff tendon transfers, allografts rotator cuff repair, xenograft rotator cuff repair and synthetic grafts rotator cuff repair. results: in this article, we focus particularly on the aetiology, pathology and prognosis of large tears, fatty infiltration and muscle atrophy of the rotator cuff. an overview of the various treatment strategies and current/future concepts are also discussed in managing patients with these types of rotator cuff deficiencies. conclusions: large tears, fatty infiltration and muscle atrophy of the cuff are challenging. an in-depth understanding of these elements may prove vital for the practising orthopedician in determining the right course of management. techniques in strengthening the repair construct using augmentation play an important role in the treatment of this condition.