Purpose: In this retrospective study we have analysed the effect of retears and muscle-malfunction on the results of the repair of 90 massive rotator cuff tears (MRCT) with a minimum follow-up of 2 years.

Materials: We reviewed 90 patients (15F,75M) with 90 massive rotator cuff tear repairs (66R, 24L). The age at surgery was 59 (45–75) years, follow-up 49 (24–134) months. 53 patients had a direct repair and transosseus fixation, 33 patients a local tendon transfer, and 4 a delta-flap. Beside clinical assessement, and evaluation of the Constant-Score, a standarised dynamic and static ultrasound examination of the rotator cuff, SSP and ISP with their kinematic contraction patterns, was performed.

Results: 51.1% rated their result as excellent, 28.9% as good, 11.1% as moderate, 5.6% as fair and 3.3% as poor. The unadapted Constant-score was 68.5 (contralateral 75.8). 61.1% had an ultrasonographically intact cuff reconstruction, 27.8% had a small retear and 12.2% had a retear > 2cm. The Constant-score of patients with an intact reconstruction was 71.6, with large retears 59.7 and with small retears 64.3. Patients with normal Type I contraction patterns of SSP and ISP had a Constant-score of 78.3 and 74.8, whereas those with a type III (little contraction) had 54.9 and 53.1.

Conclusions: 80% good and excellent subjective results show an appropriate treatment of MRCT’s. Because of the significant influence (p< 0,03) of muscle-malfunction, a preoperative ultrasonography of the rotator cuff muscles is performed to assess the muscle function and determine the indication for a muscle transfer.