Rotator Cuff Rupture: When Is Conservative and When Is Surgical Therapy Indicated? Abstract. Patients with rotator cuff tears can be treated conservatively or surgically. The treatment decision depends on the one hand on patient-specific factors like shoulder impairment, age, activity level, functional demand, and on the other hand on morphological or radiological circumstances like tear size, muscle degeneration and fatty infiltration of the rotator cuff muscles. In this review, the treatment approach of our institution is described.