Defining massive rotator cuff tears: a Delphi consensus study

Adam Schumaier, David Kovacevic, Christopher Schmidt, Andrew Green, Andrew Rokito, Charles Jobin, Ed Yian, Frances Cuomo, Jason Koh, Mohit Gilotra, Miguel Ramirez, Matthew Williams, Robert Burks, Rodney Stanley, Samer Hasan, Scott Paxton, Syed Hasan, Wesley Nottage, William Levine, Uma SrikumaranBrian Grawe

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: A standard definition for massive rotator cuff tears (MRCTs) has not been identified. The purpose of this study is to use the modified Delphi technique to determine a practical, consensus definition for MRCTs. Methods: This study is based on responses from 20 experts who participated in 4 rounds of surveys to determine a consensus definition for MRCT. Consensus was achieved when at least 70% of survey responders rated an item at least a 4 on a 5-point scale. A set of core characteristics was drafted based on literature review and then refined to achieve a consensus MRCT definition. Results: The following core characteristics reached consensus in the first round: tear size, number of tendons torn, and degree of medial retraction. Magnetic resonance imaging (MRI) and intraoperative findings reached consensus as the modalities of diagnosis. The second round determined that tear size should be measured as a relative value. An initial definition for MRCT was proposed in the third round: retraction of tendon(s) to the glenoid rim and/or a tear with ≥67% greater tuberosity exposure (65% approval). A modified definition was proposed that specified that degree of retraction should be measured in the coronal or axial plane and that the amount of greater tuberosity exposure should be measured in the sagittal plane (90% approval). Conclusions: This study determined with 90% agreement that MRCT should be defined as retraction of tendon(s) to the glenoid rim in either the coronal or axial plane and/or a tear with ≥67% of the greater tuberosity exposed measured in the sagittal plane. The measurement can be performed either with MRI or intraoperatively.

Original languageEnglish (US)
Pages (from-to)674-680
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Issue number4
StatePublished - Apr 2020
Externally publishedYes


  • Delphi Method
  • Delphi technique
  • Experts
  • Massive rotator cuff tear
  • Survey Study
  • classification
  • consensus
  • definition
  • rotator cuff tear
  • shoulder surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Defining massive rotator cuff tears: a Delphi consensus study'. Together they form a unique fingerprint.

Cite this