Abstract：
Posterosuperior rotator cuff tears range among the most common causes of shoulder complaints. While non-operative treatment is typically reserved for the elderly patient with low functional demands, surgical treatment is considered the gold standard for active patients. More precisely, an anatomic rotator cuff repair (RCR) is considered the most desirable treatment option and should be generally attempted during surgery. If an anatomic RCR is impossible, the adequate choice of treatment for irreparable rotator cuff tears remains a matter of debate among shoulder surgeons. Following a critical review of the contemporary literature, the authors suggest the following evidence- and experience-based treatment recommendation. In the non-functional, osteoarthritic shoulder, treatment strategies in the management of irreparable posterosuperior RCT include debridement-based procedures and reverse total shoulder arthroplasty as the treatment of choice. Joint-preserving procedures aimed at restoring glenohumeral biomechanics and function should be reserved for the non-osteoarthritic shoulder. Prior to these procedures, however, patients should be counseled about deteriorating results over time. Recent innovations such as the superior capsule reconstruction and the implantation of a subacromial spacer show promising short-term results, yet future studies with long-term follow-up are required to derive stronger recommendations.
摘要：
后上肩袖撕裂是肩部不适的最常见原因之一。虽然非手术治疗通常是针对功能需求低的老年患者，手术治疗被认为是活跃患者的金标准。更确切地说,解剖肩袖修复(RCR)被认为是最理想的治疗选择,一般应在手术过程中尝试.如果解剖RCR是不可能的,对于不可修复的肩袖撕裂,选择适当的治疗方法仍是肩关节外科医师争论的问题.在对当代文学进行批判性审查之后，作者提出了以下基于证据和经验的治疗建议.在非功能性的,骨关节炎肩，治疗不可修复的后上RCT的治疗策略包括基于清创术的手术和逆向全肩关节置换术作为治疗的选择.非骨关节炎的肩关节应保留旨在恢复肱骨生物力学和功能的关节保留程序。在这些程序之前，然而,随着时间的推移，应该向患者提供恶化结果的建议。最近的创新，如优越的囊重建和肩峰下间隔物的植入显示有希望的短期结果，然而，未来的研究需要长期随访，以得出更强有力的建议。
