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Background: Massive rotator cuff tears pose a challenge to shoulder surgeons. Numerous surgical management strategies have been utilized, and studies have shown varied results regarding shoulder pain, range of motion, strength, and overall function. The novel double Mac technique combines the biomechanical properties of the double-row suture and Mac stitch for the massive rotator cuff tears repair.

Aims: To describe the short and mid-term clinical and functional results of the complete repair of massive rotator cuff tears using the double Mac technique in a cohort of carefully selected patients.

Methods: Clinical records of patients operated using the double Mac technique for massive rotator cuff tears (≥ 2 tendons) from January 2018 to October 2022 were retrieved. The surgical technique is described. A prospective follow-up of patients with a minimum of six months postoperative was carried out. The Constant-Murley Shoulder Score was used to assess the function of the operated and contralateral side. Pain level was investigated using a visual analog scale, and the retearing and complications incidences. Follow-up were categorized as short (up to 34 months) and mid-term (34 to 60 months). Descriptive and bivariate statistics were used.

Results: There were 71 patients, with an average age of 61.7 years and 59.2% women. Most (66.2%) massive rotator cuff tears were degenerative, and in 80.3% compromised 4 tendons. The median follow-up was 14 months, 93% short-term. The median visual analog scale was 0. The average Constant-Murley shoulder score was 82.2, corresponding to 100.9% of the contralateral (score 82.5). There were only 3 reported complications consisting of adhesive capsulitis. No events of retearing had occurred. Most patients (91.5%) were very satisfied with the results.

Conclusion: The complete repair of massive rotator cuff tears using the double Mac arthroscopic technique yielded excellent functional results with very low or no pain at short and mid-term follow-ups. The retear rate was zero.