In rotator cuff tears, when is surgical repair indicated?

• A. Full-thickness tears with weakness or functional impairment after conservative therapy.
• B. Any tear requires immediate surgery.
• C. Only tears in younger patients require surgery.
• D. Tears always heal with time and do not require repair.

Answer: (A)

When a rotator cuff tear has progressed to a full-thickness defect and the patient has measurable weakness or functional limitation after a course of nonoperative treatment, surgical repair is indicated. The idea is that complete tears disrupt tendon–bone continuity and are less likely to heal well on their own, especially when symptoms persist despite physical therapy, pain control, and activity modification. In this scenario, repairing the tendon can restore strength and function, improve overhead activities, and prevent further decline.

Small or partial-thickness tears can often be managed nonoperatively with good results, and age alone isn’t the deciding factor—it's the presence of functional impairment from a full-thickness tear after conservative management that guides the decision to repair.