• Rocco Aicale, Nicola Poeta, Eugenio Savarese, Giulio Bernardini, Francesco Oliva, and Nicola Maffulli.
• Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy.
• Br. Med. Bull. 2022 Dec 12; 144 (1): 768976-89.

IntroductionRotator cuff tears (RCT) are a common cause of shoulder pain and disability, with massive RCT accounting for 10-40% of all rotator cuff tears.Sources Of DataA systematic search of PubMed and Scopus electronic databases was performed up to August 2022, and a total of 17 scientific articles were included in the present PRISMA compliant systematic review.Areas Of AgreementUnderstanding the geometric patterns in RCT is essential to achieve appropriate repositioning of the injured tendons in their anatomic location. The long head of the biceps tendon (LHBT) is usually exposed when defects of the anterolateral corner are present and can be easily used to augment rotator cuff repairs.Areas Of ControversyThere are no definite guideline regarding the management of massive rotator cuff tears.Growing PointsThe use of LHBT graft is safe and effective, but technically demanding. All studies were level IV articles of medium to high quality.Areas Timely For Developing ResearchProspective long term follow-up studies and randomized controlled trials are needed, adding imaging evaluation and appropriate clinical outcome measures at follow-up.© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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