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The Evolution of Treatment for Rotator Cuff Tears

      Few things have evolved in my surgical career as much as the treatment of Rotator Cuff Tears. As a resident, I had the opportunity to work with a true master shoulder surgeon, Dr Charles Rockwood. It wouldn't take too long for me to reach the point in a case in which he would proclaim: "Dr Miller, I think you've reached your level of incompetence." Many years later, as I was painfully ascending the Mount Everest of learning curves (arthroscopic treatment of cuff tears), I couldn't have agreed with him more. But persistence paid off (probably for all shoulder surgeons of my generation), and we eventually figured it out. I can now perform a decent arthroscopic cuff repair but have not attempted the ascent to more complex learning curves, including dealing with "irreparable" tears. Back in my Rockwood days, I didn't think such a thing existed, but, once again, I was wrong. For this reason, we recruited two highly talented shoulder surgeons to join our practice. The latest of these surgeons, Dr Brian Werner, is the Guest Editor for this issue of Clinics in Sports Medicine. Thank you, Brian, for all you do at the University of Virginia, and for putting together this great treatise.
      Dr Warner has crafted a logical and all-encompassing approach to addressing the treatment of rotator cuff tears. This issue begins with a review of the natural history, discusses imaging and biologics, reviews arthroscopic treatment principles, and then goes on to more complex topics: augmentation, superior capsular reconstruction, balloons, revision surgery, and reverse total shoulder arthroplasty. The issue concludes with a review of the principles for rehabilitation. It is an excellent approach to a topic that has truly evolved over the course of my career. Thank you, Dr Werner, and all contributors to this issue!