Partial repair of massive rotator cuff tears: the evolution of a concept.

Partial repair of massive rotator cuff tears has eliminated the need for tendon transfers to close large defects. Side-to-side repair is usually done as a first step, with the margins of the tear then repaired to bone. Side-to-side repair causes a "margin convenience" toward the greater tuberosity, enhancing the mechanics of the construct by decreasing the strain at the free margin of the rotator cuff tear. By combining tendon-to-tendon repair with the tendon-to-bone repair, the surgeon can create a functional rotator cuff in most patients with massive tears.