Expert consensus on reconstruction treatment for irreparable posterosuperior massive rotator cuff tears_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine, Chinese Medical Association ,  ,  , 

Corresponding?author：

Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine, Chinese Medical Association, Email: zhoubinghua@tmmu.edu.cn; , Email: zhuymail@163.com; , Email: 4415147@qq.com; , Email: chunyanj@hotmail.com

Keywords：

Massive rotator cuff tear; irreparable; reconstruction; expert consensus; modified Delphi method

DOI：

10.7507/1002-1892.202604052

Video：

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Irreparable posterosuperior massive rotator cuff tears represent a common and challenging condition in shoulder surgery. Reconstruction procedures can effectively restore the anatomical structure and function of the shoulder joint and, as an important joint-preserving treatment option for irreparable posterosuperior massive rotator cuff tears, have garnered increasing attention and application among shoulder surgeons. However, a lack of consensus currently exists regarding its definition, diagnostic criteria, and treatment strategies, leading to inconveniences in clinical decision-making and academic communication. To standardize the indications, surgical option selection, and postoperative rehabilitation strategies for the reconstruction of irreparable posterosuperior massive rotator cuff tears, the Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine of Chinese Medical Association organized experts in the relevant field to develop a consensus using a modified Delphi method, which involved two rounds of questionnaire surveys and one online expert meeting. After reviewing domestic and foreign literature, the consensus drafting group compiled the initial draft and questionnaire items. Suitable topics were selected via the first round of expert voting, and the recognition level of responses to each consensus question was determined in the second round. Online expert discussions were subsequently held to refine wording and reconcile divergent views, yielding the final consensus. A consensus is confirmed with an approval rate of no less than 85%. It is classified into three tiers: high consensus (95.0%-100%), general consensus (90.0%-94.9%), and basic consensus (85.0%-89.9%). This consensus ultimately formulated 10 recommendations focusing on core issues, including the definition and diagnosis of irreparable posterosuperior massive rotator cuff tears, the indications and timing of reconstruction surgery, the selection and application principles of commonly used reconstruction techniques, perioperative management and phased rehabilitation protocols, and the prevention and treatment of postoperative complications. This consensus aims to provide a clinical decision-making reference for orthopedic surgeons, sports medicine physicians, and rehabilitation specialists, thereby promoting the standardization and individualization of reconstruction treatment for irreparable massive rotator cuff tears and improving patient functional outcomes.

Citation： Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine, Chinese Medical Association. Expert consensus on reconstruction treatment for irreparable posterosuperior massive rotator cuff tears. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 849-859. doi: 10.7507/1002-1892.202604052 Copy

1.	Araya-quintanilla F, Gutiérrez-espinoza H, Gana-hervias G, et al. Association between type of rotator cuff tear and functional outcomes in patients with massive and irreparable rotator cuff tear: A pre-post intervention study. J Shoulder Elbow Surg, 2021, 30(6): 1393-1401.
2.	李懷勝, 馬林, 李焱, 等. 自體闊筋膜重建上關節囊治療不可修復巨大肩袖撕裂的近期療效. 中國修復重建外科雜志, 2021, 35(11): 1427-1433.
3.	唐博文, 李懷勝, 楊方程, 等. 岡上肌肌腱重建和上關節囊重建術治療不可修復后上巨大肩袖撕裂的中期效果對比. 中華醫學雜志, 2025, 105(23): 1918-1924.
4.	Kim SJ, Lee IS, Kim SH, et al. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy, 2012, 28(6): 761-768.
5.	Clark NJ, Elhassan BT. The role of tendon transfers for irreparable rotator cuff tears. Curr Rev Musculoskelet Med, 2018, 11(1): 141-149.
6.	Gerber C. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg (Am), 2006, (275): 152-160.
7.	Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy, 2013, 29(3): 459-470.
8.	Li HS, Liao YT, Jin BY, et al. Dynamic superior capsular reconstruction for irreparable massive rotator cuff tears: Histologic analysis in a rat model and short-term clinical evaluation. Am J Sports Med, 2023, 51(5): 1255-1266.
9.	Selim NM, Badawy ER. Consider long head of biceps tendon for reconstruction of massive, irreparable rotator cuff tear. Arthrosc Tec, 2021, 10(2): e457-e467.
10.	Ma L, Liao YT, Wang ZY, et al. Supraspinatus tendon reconstruction using fascia lata autograft for irreparable posterosuperior massive rotator cuff tears. Arthrosc Tec, 2023, 12(5): e629-e634.
11.	Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet, 1982, 154(5): 667-672.
12.	Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
13.	Nobuhara K, Hata Y, Komai M. Surgical-procedure and results of repair of massive tears of the rotator cuff. Clin Orthop Relat Res, 1994, (304): 54-59.
14.	Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res, 1990, (254): 92-96.
15.	Zoga AC, Kamel S, Hynes JP, et al. The evolving roles of MRI and ultrasound in first-line imaging of rotator cuff injuries. Am J Roentgenol, 2021, 217(6): 1390-1400.
16.	Collin P, Matsumura N, L?dermann A, et al. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg, 2014, 23(8): 1195-1202.
17.	Di Benedetto P, Beltrame A, Cicuto C, et al. Rotator cuff tears reparability index based on pre-operative MRI: our experience. Acta Biomed, 2019, 90(1-S): 36-46.
18.	Kim SJ, Park JS, Lee KH, et al. The development of a quantitative scoring system to predict whether a large-to-massive rotator cuff tear can be arthroscopically repaired. Bone Joint J, 2016, 98B(12): 1656-1661.
19.	Kuptniratsaikul V, Laohathaimongkol T, Umprai V, et al. Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears. BMC Musculoskelet Disord, 2019, 20: 111. doi: 10.1186/s12891-019-2485-4.
20.	Park I, Kang JS, Lee HA, et al. A novel reparability assessment scoring system for full-thickness rotator cuff tears. Orthop J Sports Med, 2020, 8(8): 2325967120940979. doi: 10.1177/2325967120940979.
21.	Guo S, Zhu Y, Song G, et al. Assessment of tendon retraction in large to massive rotator cuff tears: A modified patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability. Arthroscopy, 2020, 36(11): 2822-2830.
22.	Kim JY, Park JS, Rhee YG. Can preoperative magnetic resonance imaging predict the reparability of massive rotator cuff tears? Am J Sports Med, 2017, 45(7): 1654-1663.
23.	Kissenberth MJ, Rulewicz GJ, Hamilton SC, et al. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg, 2014, 23(7): 1023-1027.
24.	Sheean AJ, Hartzler RU, Denard PJ, et al. Preoperative radiographic risk factors for incomplete arthroscopic supraspinatus tendon repair in massive rotator cuff tears. Arthroscopy, 2018, 34(4): 1121-1127.
25.	Kim IB, Jung DW, Suh KT. Prediction of the irreparability of rotator cuff tears. Arthroscopy, 2018, 34(7): 2076-2084.
26.	Yokoya S, Nakamura Y, Harada Y, et al. Effectiveness of measuring tension during arthroscopic rotator cuff repair. J Exp Orthop, 2021, 8(1): 21. doi: 10.1186/s40634-021-00341-2.
27.	Schumaier A, Kovacevic D, Schmidt C, et al. Defining massive rotator cuff tears: a Delphi consensus study. J Shoulder Elbow Surg, 2020, 29(4): 674-680.
28.	Brolin TJ, Updegrove GF, Horneff JG. Classifications in brief: Hamada classification of massive rotator cuff tears. Clin Orthop Relat Res, 2017, 475(11): 2819-2823.
29.	Burkhart SS. Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical-results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am, 1993, 24(1): 111-123.
30.	Habermeyer P, Magosch P, Lichtenberg S. Classifications and scores of the shoulder. J Bone Joint Surg (Br), 2007, 89-B(8): 1132-1132.
31.	Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg, 2016, 25(8): 1346-1353.
32.	Li HS, Zhou BH, Tang KL. Advancement in arthroscopic superior capsular reconstruction for irreparable massive rotator cuff tear. Orthop Surg, 2021, 13(7): 1951-1959.
33.	Liao YT, Zhou BH, Mihata T. Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment. Chin Med J, 2021, 134(23): 2847-2849.
34.	Liem D, Lengers N, Dedy N, et al. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy, 2008, 24(7): 743-748.
35.	Chen YS, Kuan FC, Su WR, et al. Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears. J Orthop Surg Res, 2025, 20(1): 562. doi: 10.1186/s13018-025-05975-x.
36.	Ohta S, Komai O, Onochi Y. Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear. Arch Orthop Trauma Surg, 2020, 140(10): 1319-1325.
37.	L?dermann A, Denard PJ, Abrassart S, et al. Achilles tendon allograft for an irreparable massive rotator cuff tear with bony deficiency of the greater tuberosity. Knee Surg Sports Traumatol Arthrosc, 2017, 25(7): 2147-2150.
38.	Benini A, Wagenhauser FJ. Periarthropathia humeroscapularis and cervical disk herniation. Neurochirurgia, 1989, 32(2): 47-49.
39.	Jeon IH, Kholinne E. Advancements in the management of irreparable rotator cuff tears. Indian J Orthop, 2025, 59(6): 731-742.
40.	Yoo JC, Ahn JH, Yang JH, et al. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy, 2009, 25(6): 573-582.
41.	Nakashima S, Kawada M, Takeshita Y, et al. Compensatory mechanisms to maintain glenohumeral joint stability in rotator cuff tears of differing severity during activities of daily living: A musculoskeletal model simulation study. PLoS One, 2025, 20(10): e0335647. doi: 10.1371/journal.pone.0335647.
42.	Lee SH, Nam DJ, Kim SJ, et al. Comparison of clinical and structural outcomes by subscapularis tendon status in massive rotator cuff tear. Am J Sports Med, 2017, 45(11): 2555-2562.
43.	Fan N, Yuan S, Du P, et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg, 2022, 31(3): 656-667.
44.	Wang ZY, Zhang CK, Wang J, et al. Comparative outcomes of supraspinatus tendon reconstruction and superior capsule reconstruction for massive irreparable posterosuperior rotator cuff tears. Sci Rep, 2025, 15(1): 31322. doi: 10.1038/s41598-025-17198-5.
45.	Liao YT, Wang J, Zhou Z, et al. Supraspinatus tendon reconstruction versus the bridging technique in a rat model: Histological, biomechanical, and functional outcomes. Am J Sports Med, 2024, 52(10): 2628-2638.
46.	Baek CH, Lee DH, Kim JG. Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg, 2022, 31(9): 1810-1822.
47.	尚西亮, 呂婧儀, 張樹蓉, 等. 肱二頭肌長頭腱轉位上關節囊重建治療巨大不可修復性肩袖撕裂的生物力學與臨床研究. 中華骨科雜志, 2021, 41(9): 559-567.
48.	尚西亮, 呂婧儀, 陳疾忤, 等. 關節鏡下肱二頭肌長頭腱轉位固定輔助替代上關節囊重建 (Chinese Way) 修補巨大及不可修復肩袖撕裂的臨床療效. 中國運動醫學雜志, 2019, 38(8): 652-657.
49.	Liao YT, Zhou Z, Wang J, et al. Fascia lata autografts achieve interface healing with the supraspinatus muscle histologically and mechanically in a rat supraspinatus tendon reconstruction model for massive irreparable rotator cuff tears. Arthroscopy, 2024, 40(11): 2655-2666.
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1. Araya-quintanilla F, Gutiérrez-espinoza H, Gana-hervias G, et al. Association between type of rotator cuff tear and functional outcomes in patients with massive and irreparable rotator cuff tear: A pre-post intervention study. J Shoulder Elbow Surg, 2021, 30(6): 1393-1401.
2. 李懷勝, 馬林, 李焱, 等. 自體闊筋膜重建上關節囊治療不可修復巨大肩袖撕裂的近期療效. 中國修復重建外科雜志, 2021, 35(11): 1427-1433.
3. 唐博文, 李懷勝, 楊方程, 等. 岡上肌肌腱重建和上關節囊重建術治療不可修復后上巨大肩袖撕裂的中期效果對比. 中華醫學雜志, 2025, 105(23): 1918-1924.
4. Kim SJ, Lee IS, Kim SH, et al. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy, 2012, 28(6): 761-768.
5. Clark NJ, Elhassan BT. The role of tendon transfers for irreparable rotator cuff tears. Curr Rev Musculoskelet Med, 2018, 11(1): 141-149.
6. Gerber C. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg (Am), 2006, (275): 152-160.
7. Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy, 2013, 29(3): 459-470.
8. Li HS, Liao YT, Jin BY, et al. Dynamic superior capsular reconstruction for irreparable massive rotator cuff tears: Histologic analysis in a rat model and short-term clinical evaluation. Am J Sports Med, 2023, 51(5): 1255-1266.
9. Selim NM, Badawy ER. Consider long head of biceps tendon for reconstruction of massive, irreparable rotator cuff tear. Arthrosc Tec, 2021, 10(2): e457-e467.
10. Ma L, Liao YT, Wang ZY, et al. Supraspinatus tendon reconstruction using fascia lata autograft for irreparable posterosuperior massive rotator cuff tears. Arthrosc Tec, 2023, 12(5): e629-e634.
11. Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet, 1982, 154(5): 667-672.
12. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
13. Nobuhara K, Hata Y, Komai M. Surgical-procedure and results of repair of massive tears of the rotator cuff. Clin Orthop Relat Res, 1994, (304): 54-59.
14. Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res, 1990, (254): 92-96.
15. Zoga AC, Kamel S, Hynes JP, et al. The evolving roles of MRI and ultrasound in first-line imaging of rotator cuff injuries. Am J Roentgenol, 2021, 217(6): 1390-1400.
16. Collin P, Matsumura N, L?dermann A, et al. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg, 2014, 23(8): 1195-1202.
17. Di Benedetto P, Beltrame A, Cicuto C, et al. Rotator cuff tears reparability index based on pre-operative MRI: our experience. Acta Biomed, 2019, 90(1-S): 36-46.
18. Kim SJ, Park JS, Lee KH, et al. The development of a quantitative scoring system to predict whether a large-to-massive rotator cuff tear can be arthroscopically repaired. Bone Joint J, 2016, 98B(12): 1656-1661.
19. Kuptniratsaikul V, Laohathaimongkol T, Umprai V, et al. Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears. BMC Musculoskelet Disord, 2019, 20: 111. doi: 10.1186/s12891-019-2485-4.
20. Park I, Kang JS, Lee HA, et al. A novel reparability assessment scoring system for full-thickness rotator cuff tears. Orthop J Sports Med, 2020, 8(8): 2325967120940979. doi: 10.1177/2325967120940979.
21. Guo S, Zhu Y, Song G, et al. Assessment of tendon retraction in large to massive rotator cuff tears: A modified patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability. Arthroscopy, 2020, 36(11): 2822-2830.
22. Kim JY, Park JS, Rhee YG. Can preoperative magnetic resonance imaging predict the reparability of massive rotator cuff tears? Am J Sports Med, 2017, 45(7): 1654-1663.
23. Kissenberth MJ, Rulewicz GJ, Hamilton SC, et al. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg, 2014, 23(7): 1023-1027.
24. Sheean AJ, Hartzler RU, Denard PJ, et al. Preoperative radiographic risk factors for incomplete arthroscopic supraspinatus tendon repair in massive rotator cuff tears. Arthroscopy, 2018, 34(4): 1121-1127.
25. Kim IB, Jung DW, Suh KT. Prediction of the irreparability of rotator cuff tears. Arthroscopy, 2018, 34(7): 2076-2084.
26. Yokoya S, Nakamura Y, Harada Y, et al. Effectiveness of measuring tension during arthroscopic rotator cuff repair. J Exp Orthop, 2021, 8(1): 21. doi: 10.1186/s40634-021-00341-2.
27. Schumaier A, Kovacevic D, Schmidt C, et al. Defining massive rotator cuff tears: a Delphi consensus study. J Shoulder Elbow Surg, 2020, 29(4): 674-680.
28. Brolin TJ, Updegrove GF, Horneff JG. Classifications in brief: Hamada classification of massive rotator cuff tears. Clin Orthop Relat Res, 2017, 475(11): 2819-2823.
29. Burkhart SS. Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical-results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am, 1993, 24(1): 111-123.
30. Habermeyer P, Magosch P, Lichtenberg S. Classifications and scores of the shoulder. J Bone Joint Surg (Br), 2007, 89-B(8): 1132-1132.
31. Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg, 2016, 25(8): 1346-1353.
32. Li HS, Zhou BH, Tang KL. Advancement in arthroscopic superior capsular reconstruction for irreparable massive rotator cuff tear. Orthop Surg, 2021, 13(7): 1951-1959.
33. Liao YT, Zhou BH, Mihata T. Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment. Chin Med J, 2021, 134(23): 2847-2849.
34. Liem D, Lengers N, Dedy N, et al. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy, 2008, 24(7): 743-748.
35. Chen YS, Kuan FC, Su WR, et al. Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears. J Orthop Surg Res, 2025, 20(1): 562. doi: 10.1186/s13018-025-05975-x.
36. Ohta S, Komai O, Onochi Y. Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear. Arch Orthop Trauma Surg, 2020, 140(10): 1319-1325.
37. L?dermann A, Denard PJ, Abrassart S, et al. Achilles tendon allograft for an irreparable massive rotator cuff tear with bony deficiency of the greater tuberosity. Knee Surg Sports Traumatol Arthrosc, 2017, 25(7): 2147-2150.
38. Benini A, Wagenhauser FJ. Periarthropathia humeroscapularis and cervical disk herniation. Neurochirurgia, 1989, 32(2): 47-49.
39. Jeon IH, Kholinne E. Advancements in the management of irreparable rotator cuff tears. Indian J Orthop, 2025, 59(6): 731-742.
40. Yoo JC, Ahn JH, Yang JH, et al. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy, 2009, 25(6): 573-582.
41. Nakashima S, Kawada M, Takeshita Y, et al. Compensatory mechanisms to maintain glenohumeral joint stability in rotator cuff tears of differing severity during activities of daily living: A musculoskeletal model simulation study. PLoS One, 2025, 20(10): e0335647. doi: 10.1371/journal.pone.0335647.
42. Lee SH, Nam DJ, Kim SJ, et al. Comparison of clinical and structural outcomes by subscapularis tendon status in massive rotator cuff tear. Am J Sports Med, 2017, 45(11): 2555-2562.
43. Fan N, Yuan S, Du P, et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg, 2022, 31(3): 656-667.
44. Wang ZY, Zhang CK, Wang J, et al. Comparative outcomes of supraspinatus tendon reconstruction and superior capsule reconstruction for massive irreparable posterosuperior rotator cuff tears. Sci Rep, 2025, 15(1): 31322. doi: 10.1038/s41598-025-17198-5.
45. Liao YT, Wang J, Zhou Z, et al. Supraspinatus tendon reconstruction versus the bridging technique in a rat model: Histological, biomechanical, and functional outcomes. Am J Sports Med, 2024, 52(10): 2628-2638.
46. Baek CH, Lee DH, Kim JG. Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg, 2022, 31(9): 1810-1822.
47. 尚西亮, 呂婧儀, 張樹蓉, 等. 肱二頭肌長頭腱轉位上關節囊重建治療巨大不可修復性肩袖撕裂的生物力學與臨床研究. 中華骨科雜志, 2021, 41(9): 559-567.
48. 尚西亮, 呂婧儀, 陳疾忤, 等. 關節鏡下肱二頭肌長頭腱轉位固定輔助替代上關節囊重建 (Chinese Way) 修補巨大及不可修復肩袖撕裂的臨床療效. 中國運動醫學雜志, 2019, 38(8): 652-657.
49. Liao YT, Zhou Z, Wang J, et al. Fascia lata autografts achieve interface healing with the supraspinatus muscle histologically and mechanically in a rat supraspinatus tendon reconstruction model for massive irreparable rotator cuff tears. Arthroscopy, 2024, 40(11): 2655-2666.
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Chinese Journal of Reparative and Reconstructive Surgery

Expert consensus on reconstruction treatment for irreparable posterosuperior massive rotator cuff tears

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