Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

천경아,김민성,김영주 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.5

Objective: To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. Materials and Methods: The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. Results: The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. Conclusion: MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears. Objective: To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. Materials and Methods: The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. Results: The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. Conclusion: MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.

Does the Use of Injectable Atelocollagen during Arthroscopic Rotator Cuff Repair Improve Clinical and Structural Outcomes?

In Bo Kim,Eun Yeol Kim,Kuk Pil Lim,Ki Seong Heo 대한견주관절학회 2019 대한견주관절의학회지 Vol.22 No.4

Background: Since the establishment of biological augmentation to improve the treatment of rotator cuff tears, it is imperative to explore newer techniques to reduce the retear rate and improve long-term shoulder function after rotator cuff repair. This study was undertaken to determine the consequences of a gel-type atelocollagen injection during arthroscopic rotator cuff repair on clinical outcomes, and evaluate its effect on structural integrity. Methods: Between January 2014 and June 2015, 121 patients with full thickness rotator cuff tears underwent arthroscopic rotator cuff repair. Of these, 61 patients were subjected to arthroscopic rotator cuff repair in combination with an atelocollagen injection (group I), and 60 patients underwent arthroscopic rotator cuff repair alone (group II). The visual analogue scale (VAS) for pain and the Korean Shoulder Society (KSS) scores were evaluated preoperatively and postoperatively. Magnetic resonance imaging (MRI) was performed at 6 months postoperatively, to assess the integrity of the repair. Results: VAS scores were significantly lower in group I than in group II at 3, 7, and 14 days after surgery. KSS scores showed no significant difference between groups in the 24 months period of follow-up. No significant difference was obtained in the healing rate of the rotator cuff tear at 6 months postoperatively (p=0.529). Conclusions: Although a gel-type atelocollagen injection results in reduced pain in patients at 2 weeks after surgery, our study does not substantiate the administration of atelocollagen during rotator cuff repair to improve the clinical outcomes and healing of the rotator cuff.

Difference of Critical Shoulder Angle (CSA) According to Minimal Rotation: Can Minimal Rotation of the Scapula Be Allowed in the Evaluation of CSA?

김정한,곽희철,김창완,이창락,권용욱,서형원 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.3

Background: Minimal rotation of the scapula may affect the measurement of critical shoulder angle (CSA). We investigated the difference in the CSA measured in minimal rotation between the patients with rotator cuff tear and those without non-rotator cuff tear and the CSA measurement error by comparing with computed tomography (CT). Methods: We retrospectively reviewed patients with full-thickness rotator cuff tear and whose X-ray views correspond to Suter-Henninger classification type A1 and C1. The CSA values between the normal control group (without rotator cuff tear) and the rotator cuff tear group were compared according to A1 type and C1 type. In the rotator cuff tear group, we compared the CSA values measured by using X-ray and CT. Results: A total of 238 patients (rotator cuff tear group, 139 patients; normal cuff group, 99 patients) were included in this study. The mean CSA of the rotator cuff tear group was 33.4° ± 3.5°, and that of the normal cuff group was 32.6° ± 3.9° (p = 0.085). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.7° ± 3.5° and 33.7° ± 3.5°, respectively, in the rotator cuff tear group and 30.5° ± 3.1° and 33.1 ± 3.9°, respectively, in the normal cuff group (p = 0.024 and p = 0.216, respectively). The mean CSA was 32.5° ± 3.1° in CT and 33.3° ± 3.2° in X-ray (p = 0.184). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.6° ± 3.6° and 32.5° ± 2.4°, respectively, in CT and 32.5° ± 3.5° and 34.2° ± 2.6°, respectively, in X-ray (p = 0.905 and p = 0.017, respectively). Conclusions: The X-ray view corresponding to Suter-Henninger classification type A1 or CT-reconstructed image can be used to reduce the measurement error and obtain reliable CSA values. The CSA measured on the X-ray view corresponding to Suter-Henninger classification type A1 may be related with rotator cuff tear.

Progression of fatty degeneration of rotator cuff muscles after cuff repairs

Young Lae Moon,Boseon Kim,Sang Ha Park 대한정형외과 스포츠의학회 2015 Arthroscopy and Orthopedic Sports Medicine Vol.2 No.1

reBackground: To evaluate fatty degeneration and atrophy of rotator cuff muscles in patients with normal cuffs and in patients who received repairs of rotator cuff tears. Methods: We chose 328 patients with normal cuffs, henceforth called the “normal group”. The normal group was subcategorized according to age. Further, we chose 41 patients with cuff tears, henceforth called the “cuff tear group”, who had received reparative surgeries. The cuff tear group was divided into 2 subgroups: a cuff “repaired group” that rotator cuff tears were successfully repaired and a “re-tear group” that cuff repairs were unsuccessful and led to a re- tear. The repaired group included 30 patients and the re-tear group included 11 patients. The radiological parameters (fatty degeneration and atrophy) and clinical outcomes (visual analogue scale, UCLA, Constant, and Oxford scores) were evaluated. Results: We found that the extent of fatty degeneration and atrophy of the cuff muscles was irrespective of the aging process. Compared to the normal group, we found the cuff tear group had a significantly greater fatty degeneration and atrophy of the rotator cuff muscles. Within the cuff tear group, the re-tear group had a significantly more deteriorated fatty degeneration at the follow-up magnetic resonance imaging (MRI) than at the initial MRI (P = 0.024) and more muscle atrophy than the repaired group; there was no statistical significance. Although the clinical markers were more satisfactory in the repaired group than the re-tear group after surgery, there was no statistical significance. Conclusion: Fatty degeneration and atrophy of the rotator cuff muscles were not affected by the normal aging process. However, we found that fatty degeneration was accelerated following cuff tears even when the tear had been repaired. Lastly, we found that a preoperative fatty degeneration of more than grade 3 was associated with a higher re-tear rate of the rotator cuffs.

Outcomes of closed manipulation and arthroscopic repair for rotator cuff tears combined with shoulder stiffness

Sung-Weon Jung,Byung-Woo An,Sang-Soo Kang,Seung-Bo Shim,Min Jeong 대한정형외과 스포츠의학회 2014 Arthroscopy and Orthopedic Sports Medicine Vol.1 No.2

Background: Some patients with rotator cuff tears have preoperative shoulder stiffness, and this may affect the functional outcomes after repair of the rotator cuffs. The purpose of this study was to evaluate the outcomes of closed manipulation and arthroscopic repair of rotator cuff tears in patients with combined preoperative shoulder stiffness. Methods: Of the 200 patients who underwent arthroscopic rotator cuff repair from January 2008 to December 2012, 18 patients had preoperative shoulder stiffness at the time of repair. The incidence of preoperative shoulder stiffness was 9.0% (18 of 200 patients). All patients underwent closed manipulation and arthroscopic rotator cuff repair concomitantly, and had a sling with an abduction pillow for 6 weeks except when changing clothes. All patients were evaluated preoperatively and at a minimum of 1-year follow-up using the visual analog scale (VAS) for pain, Constant score, and ultrasonograpy. Results: The mean preoperative VAS and Constant scores were 7.6 and 50.6, respectively. The mean VAS score at the last follow-up was 2.8, and the mean Constant score was 82.4. The functional outcomes improved compared with the preoperative state (P < 0.001). Results were in 9 cases “excellent”, in 5 cases “good”, in 2 cases “fair”, and in 2 cases “poor”. Of the 5 patients who showed severe shoulder stiffness preoperatively, 2 later showed poor functional outcomes. Repair integrities noted postoperatively were 12 intact cuffs, 5 partial-thickness tears, and 1 full-thickness tear, as determined by the Naqvi classification. Conclusion: We suggest that concomitant closed manipulation and arthroscopic rotator cuff repair could be a simple and an effective surgical treatment for rotator cuff tears combined with shoulder stiffness.

후하방 회전근 개 파열과 상완이두박근 장두건 병변과의 연관 관계에 대한 후향적 분석

서승석(Seung Suk Seo),김정한(Jung Han Kim),최장석(Jang Seok Choi),김전교(Jeon Gyo Kim) 대한견주관절의학회 2011 대한견주관절의학회지 Vol.14 No.1

목적: 후하방 회전근개 파열과 상완이두박근 장두건의 관계에 대해서 명백히 알려진 바가 없다. 후하방 회전근개 파열에서 회전근 파열의 개수 및 회전근개의 퇴화 정도에 따른 상완이두박근 장두건의 병변의 차이를 비교하여 후하방 회전근개의 파열이 상완이두박근 장두건에 미치는 영향에 대하여 알아보고자 하였다. 대상 및 방법: 2002년부터 2009년까지 수술을 받은 후하방 회전근개 파열인 65명을 연구의 대상으로 설정하였다. 회전근개의 역동적 안정화에 영향을 줄 뿐만 아니라 상완이두박근 장두건에도 영향을 줄 것으로 생각되는 인자로 회전근파열의 개수 및 회전근개의 퇴화 정도로 설정을 하였다. 결과: 회전근개 파열의 개수에 의하여 극상건만 파열이 있는 군에서는 상완이두박근 장두건의 병변이 동반된 경우는 51예 중에서 11예, 극하건, 소원형건까지 포함한 파열군에서는 14예 중 8예 동반되어 두 군간 통계적으로 유의한 차이를 보였다 (p=0.0095). 상완이두박근 장두건파열이 동반된 군에서 회전근개의 파열이 크게 발생하며 이것은 통계적으로 유의한 차이를 보였다 (p=0.049). 또한 두 군간의 상완이두박근 장두건의 병변의 분포를 보았을 시 제 2형 전후 관절와순 병변은 통계적으로 유의한 차이를 보였다 (p=0.0073). Tangent sign 및 Goutallier classification을 통한 회전근 개 퇴행성 변화와 상완이두박근 장두건 병변은 통계적으로 유의한 관련을 보이지 않았다. 결론: 후상방 회전근개 파열은 상완이두박근 장두건에 영향을 미칠것으로 사료되며, 특히 이환된 회전근개의 개수가 상완이두박근 장두건의 병변에 높은 영향을 미칠것으로 생각되나 퇴행성의 정도는 영향을 미치지 않을 것으로 사료된다. Purpose: Not much is known about the obvious relationship between posteroinferior rotator cuff tear and biceps lesion. The purpose of this study is to analyze the effect of posteroinferior rotator cuff tear on a biceps lesions by comparing the rotator cuff tear and biceps lesions with the number of cuff tears and the degree of degeneration of the rotator cuff. Materials and Methods: 65 patients who underwent surgery for a posteroinferior rotator cuff tear from 2002 to 2009 were included as subjects. The study determined the factors (the number of cuff tears and the degree of degeneration as assessed by MRI) that affected biceps lesions and the kinematic stability of the rotator cuff. Results: Biceps lesion was noted 11 patients among the 51 patients with supraspinatus tendon tears and in 8 patients among the 14 patients with supraspinatus, infraspinatus or teres minor tendon tears, and there was a statistically significant difference between those two groups (p=0.0095). The number of cuff tears was proportional to biceps lesion with statistical significance (p=0.0095). Among the biceps lesions, SLAP II lesion showed a statistically different distribution according to the number of cuff tears (p= 0.0073). The degeneration factors (Goutallier’s classification and the tangent sign) had no correlations with biceps lesion. Conclusion: Posterosuperior cuff tear may affect biceps lesion. Especially, the number of cuff tears has a close relationship, but the degenerative indicators have no relationship with biceps lesion.

단순 방사선 사진에서 견봉 및 상완골 대결절의 퇴행성 변화와 MRI상 회전근 개 파열 정도와의 연관성

최정윤(Jung-Yun Choi),염재광(Jae-Mwang Yum),송민철(Min-Cheol Song) 대한견주관절의학회 2013 대한견주관절의학회지 Vol.16 No.1

목적: 단순 방사선 사진상에서 견봉 및 상완골 대결절의 퇴행성 변화의 정도와 회전근 개 파열의 크기 사이의 연관성을 알아보고자 하였다. 대상 및 방법: 견관절의 자기 공명 영상을 시행한 퇴행성 회전근 개 파열 실험군 234예와 회전근 개 파열이 없는 대조군 284예 등 총 518예를 대상으로 하였다. 견관절 방사선 단순 촬영에서 퇴행성 변화의 정도를 관절와-상완 관절의 퇴행성 변화를 제외한 견봉과 대결절에서 골극의 길이와 형태의 변형에 따라 분류하였고, 자기 공명 영상에서 회전근 개의 파열의 정도 및 전층 파열의 크기를 분류하였다. 회전근 개의 파열의 정도와 크기에 따른 견봉 및 상완골 대결절의 퇴행성 변화 정도와의 연관성에 대해 알아 보았다. 결과: 견관절 단순 방사선 사진에서 보이는 견봉 및 상완골 대결절의 퇴행성 변화에 따른 MRI상 회전근개 파열의 정도는 유의한 차이를 보였고(p<0.001), 견봉 및 상완골 대결절의 단순 방사선상 퇴행성 변화가 증가할수록 회전근 개 파열의 크기가 커지는 경향이 있었으며(p<0.001), 부분층 파열 보다 전층 파열 가능성이 높은 것으로 나타났다(p<0.001). 또한 고령 및 여자에서 회전근 개의 파열이 더 심하다는 결과를 얻었다(p<0.001, p<0.001). 결론: 퇴행성 회전근 개 파열 환자에서 견관절의 단순 방사선 사진상 견봉 및 상완골 대결절의 퇴행성 변화가 심할수록 회전근 개 파열의 크기가 더 크고, 나이와 성별도 관련 인자 중 하나로 사료된다. Purpose: The purpose of this study is to analyze the correlation between the degree of torn rotator cuff as recorded by MRI and degenerative change of acromion and greater tuberosity of humerus determined by simple radiographs. Materials and Methods: Of the 518 cases included in this study, a group of 234 cases had a chronic rotator cuff tear and a control group of 284 cases had an intact rotator cuff in shoulder MRI. The degree of degenerative changes was classified according to the length of spur and morphological change of acromion and greater tuberosity through the true anteroposterior simple radiograph in supraspinatus outlet view. The degree of tear (partial-thickness or full-thickness tear) and the size of complete rotator cuff tear were analyzed according to the MRI findings of shoulder. The authors also evaluated the correlation between the degree and size of torn rotator cuff and the degenerative change of acromion and greater tuberosity. Results: There were significant differences in the size and extent of torn rotator cuff according to the age, sex and degenerative change of acromion and greater tuberosity of humerus (p<0.001). More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff (p<0.001). In addition, the higher degree and larger size of torn rotator cuff were noted in older age subjects (p<0.001) and in the female group (p<0.001). Conclusion: More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff. Therefore, if a high degree of degenerative change of the acromion and greater tuberosity on simple radiograph is noted, the possibility of degenerative rotator cuff tear should be considered. In addition, the age and sex could be associative factors for larger size of torn rotator cuff.

회전근 개 파열에서 Apoptotic Cell의 발현과 조직병리학적 소견

서지훈(Ji-Hoon Suh),홍수헌(Soo-Heon Hong),박재범(Jae-Bum Park),김종민(Jong Min Kim),전재명(Jae-Myeung Chun) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.4

목적: 회전근 개 파열 환자에서 파열 크기, apoptotic cell의 발현빈도(apoptotic index), 조직병리학적 소견들의 상호 연관성을 알아보고자 하였다. 대상 및 방법: 회전근 개 파열로 수술을 시행한 63예를 대상으로 하였으며, 소, 중, 대, 광범위 파열이 각각 2예, 22예, 22예, 17예였다. 조직병리학적 변화의 평가를 위해서는 H&E 염색을, apoptotic index 의 조사를 위해서는 TUNEL염색을 사용하였고, 이들과 파열 크기와의 관계를 연구 분석하였다. 결과: 파열의 크기에 따른 섬유 모세포의 조밀도, 활액막 비대층 및 혈관 증식의 정도 등은 통계적인 차이는 없었다. Apoptotic cell은 모든 예에서 관찰되었으며 주로 파열부위에 집중되어 있는 양상을 보였다. 파열 크기에 따른 apoptotic index는 소파열에서 58.50, 중파열에서 27.25, 대파열에서 33.29, 광범위 파열에서 31.96이었으며, 통계학적으로 유의한 차이는 없었다. 결론: 회전근 개 파열에서 apoptotic index나 섬유모세포 조밀도, 활액막 비대, 혈관증식 등의 조직병리 소견들은 파열의 크기에 따른 통계적으로 유의한 차이가 없었으며, 그들 지표 서로 간에도 상관관계가 없었다. Purpose: We analyzed the relationship between the size of the torn rotator cuff and the frequency of finding apoptotic cells (apoptotic index) or pathological degeneration in the rotator cuff. Materials and Methods: The edges of torn supraspinatus tendons were obtained from patients with rotator cuff tear (n=63). The study group consisted of 2 small, 22 medium, 22 large and 17 massive tears. For the histopathologic evaluation, the H&E stained sections of the torn supraspinatus tendons were examined. Apoptosis was detected with TUNEL assay. We analyzed the relationships between the tear size and the pathologic findings or the apoptotic index. Results: Significant differences could not be found for the fibroblast cellularity, thickening of the synovial lining and proliferation of blood vessels according to the size of the rotator cuff tear. All the specimens had apoptotic cells that were concentrated around the margin of the tear site. The apoptotic indexes according to the tear size were 58.50 for the small tears, 27.25 for the medium tears, 33.29 for the large tears and 31.96 for the massive tears. No significant correlation was found between the tear size and the apoptotic index. Conclusion: There were no significant differences in the apoptotic indices, the fibroblast cellularity, the thickening of the synovial lining and the proliferation of blood vessels according to the size of the rotator cuff tear, and there were no correlations between the apoptotic index and the histopathologic findings.

Repair Integrity and Functional Outcomes after Arthroscopic Repair of Transtendinous Full-thickness Rotator Cuff Tears Minimum Two-year Follow-up

Kyung Cheon Kim,Woo-Yong Lee,Hyun Dae Shin,Young-Mo Kim,Sun Cheol Han 대한견주관절의학회 2017 대한견주관절학회지 Vol.20 No.4

Background: To evaluate the clinical outcomes and associated repair integrity in patients treated with arthroscopic repair for a transtendinous rotator cuff tear followed by resection of the remnant rotator cuff tendon. Methods: Between July 2007 and July 2011, we retrospectively reviewed patients who were treated for transtendinous full-thickness tears in the tendinous portion of the rotator cuff by arthroscopic repair. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score, a visual analogue scale (VAS) pain score, and range of motion (ROM). The repair integrity was determined by magnetic resonance imaging or ultrasonography. Results: There were 19 shoulders with transtendinous full-thickness tears in the tendinous portion of the rotator cuff. The ASES, UCLA, Constant-Murley, and VAS pain scores showed significant improvements in function and symptoms (all p<0.001). The active ROM for forward flexion and abduction was also significantly improved (p=0.002 and p<0.001, respectively). The postoperative radiological examination showed cuff integrity without a re-tear in 68.4% of patients. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and re-torn group (p=0.530, p=0.885, and p=0.262, respectively). Conclusions: Although repair of transtendinous rotator cuff tears followed by resection of the remnant rotator cuff tendon in the footprint has a relatively high re-tear rate, no significant difference was observed in the short-term clinical results between the re-tear and healed groups.

광범위 회전근 개 파열의 봉합술

신상진(Sang-Jin Shin) 대한견주관절의학회 2010 대한견주관절의학회지 Vol.13 No.1

목적: 광범위 회전근 개 파열은 파열단의 내측 퇴축, 근위축 및 지방 변성과 함께 주변 조직과의 유착 등으로 해부학적 봉합이 불가능한 경우가 많다. 본 종설에서는 광범위 회전근 개 파열의 여러 가지 치료 방법 중 봉합술에 대하여 문헌 고찰과 함께 임상 결과 향상과 재파열율을 감소시키고 치유력을 높일 수 있는 방법을 알아보고자 한다. 대상 및 방법: 광범위 회전근 개 파열 봉합술의 선택은 환자의 나이, 동반 질환, 통증, 운동 범위 감소, 근력 약화 등의 임상 증상 및 재활 의지 등 환자와 관련된 요인과, 회전근 개 파열 기간, 크기, 퇴축 및 지방 변성 정도 등은 회전근 개와 관련된 요인을 고려하여 선택해야 한다. 결과: 조직의 가동성이 떨어져 해부학적 봉합이 어려운 광범위 회전근 개 파열은 주변 조직 유리 술과 간격 활주 방법으로 가동성을 증가시켜 봉합할 수 있다. 주변 조직 유리술을 시행하고 회전근 개의 가동성을 증가시켜도 해부학적 봉합이 불가능한 광범위 회전근 개 파열은 부분 봉합, 변연 수렴 술식 및 상완 이두건 절제 및 고정술 등의 대체 술식을 고려할 수 있다. 광범위 회전근개 파열 환자에서 견봉하 감압술 및 회전근 개 봉합술에 관한 여러 보고는 통증 감소, 견관절 기능 및 근력 회복 등 만족할만한 임상 결과를 보고하고 있으나 장기 추시 결과 높은 재파열율이 관찰되고 있다. 결론: 광범위 회전근 개 파열의 치료는 아직까지 높은 재파열 발생율로 해결해야 할 과제가 많으나 광범위 파열의 병인, 진행 과정 및 임상 양상에 대한 이해와 재파열 예후 인자 분석 등을 통해 향상된 치료 성적을 얻을 수 있을 것으로 사료된다. Purpose: Anatomical repair of massive rotator cuff tear has been technically challenging because of medial retraction, muscle atrophy and fatty degeneration. Among several treatment options for massive rotator cuff tear, we reviewed rotator cuff repairs and investigated modalities for improvement of clinical outcomes, decreasing the re-tear rate, and increasing healing. Materials and Methods: Patient-related factors and rotator cuff-related factors were the two major groups of factors we considered when choosing a treatment plan. Results: Mobilization of a massive rotator cuff tear was increased by soft tissue release and by the interval slide technique. After meticulous soft tissue release, anatomical repair could be achieved. If the injury was not amenable to anatomical repair, alternative treatment options such as partial repair, the margin convergence technique and augmentation with a tenotomized biceps tendon were considered. Many reports of massive rotator cuff repair demonstrated satisfactory clinical outcomes, decreased pain, recovery of shoulder functions, and increases in muscle strength. However, the re-tear rate had been reported to be relatively high in long-term follow-up. Conclusion: Despite a high re-tear rate after massive rotator cuff repair, a better understanding of the pathogenesis, progression and clinical symptoms of massive rotator cuff tear and improved surgical materials and techniques will lead to satisfactory clinical outcomes.