Editorial Commentary: Muscle Advancement, Footprint Medialization, and Repair Medialization Could Improve Healing and Clinical Outcomes of Massive Rotator Cuff Tears as a Result of Low-Tension Repair

The goal of massive, retracted rotator cuff repair surgery is structural healing that produces pain relief and strength restoration. Healing is difficult to achieve in patients with large, retracted, chronic, and fatty degenerated tears. High repair tension previously has been shown to be a risk factor for clinically and structurally failed repairs. Repair tension can be decreased by arthroscopic mobilization and muscle advancement (AMA) of the supraspinatus and infraspinatus muscle bellies from their scapular origins with subsequent lateralization of the muscle-tendon units toward the repair site. Linked double-row repair of the tendons after AMA has been shown to improve the outcomes of repairs in high-risk rotator cuff repairs. Surgeons should consider adding AMA to their intraoperative armamentarium for use in retracted cuff tears when traditional techniques fail to achieve a low-tension repair state.