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Department of Orthopaedic Surgery, Michael Reese Hospital and Medical Center, Chicago, Illinois 60616.
It is essential to understand shoulder anatomy and the pathology and extent of a rotator cuff tear before an effective repair can be achieved. Most surgical-repair failures can be avoided by: (1) achieving adequate healing of the deltoid that has been detached from the acromion, (2) not excising too much of the acromion, (3) correctly repairing the rotator cuff, including intimal tears, and (4) carefully preserving the nerve supply to important shoulder girdle muscles. Nevertheless, if a complication arises, it must be correctly managed in order to salvage shoulder function.
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