CME expires July 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) provides a case-based, evidence-driven update on the nonarthroplasty surgical management of massive irreparable rotator cuff tears (MIRCTs), with a particular focus on younger, active patients who are poor candidates for reverse total shoulder arthroplasty (RTSA). As MIRCTs are increasingly recognized in degenerative and posttraumatic contexts, this lecture equips shoulder surgeons with the diagnostic tools, decision-making strategies, and surgical techniques required to optimize patient outcomes via joint-preserving treatment options.

Editor 
Edward Walker Gallego, MD, FAAOS

Learning Objectives

• Describe the epidemiology, pathophysiology, and diagnostic criteria for massive irreparable rotator cuff tears, including clinical signs and imaging study findings that differentiate reparable rotator cuff tears from irreparable rotator cuff tears.
• Evaluate evidence-based advantages and limitations of nonarthroplasty treatment options, such as débridement, partial repair, superior capsule reconstruction, tendon transfers, and subacromial balloon spacers.
• Interpret patient-specific factors, including age, functional demands, imaging study findings, and rehabilitation potential, to guide appropriate surgical management of massive irreparable rotator cuff tears.
• Apply clinical decision-making algorithms to stratify patients with a massive irreparable rotator cuff tear based on their main symptom (pain versus functional loss), motion status, and anatomic deficiencies, with an emphasis on individualized and shared decision making.
• Assess current outcomes data and gaps in the literature with regard to the nonarthroplasty surgical management of massive irreparable rotator cuff tears, including complication rates, revision rates, and cost-effectiveness across techniques.

Earn up to 5 AMA PRA Category 1 CME credits™.