2022 Specialty Day Access Pass-Session IX: Shoulder/Rotator Cuff

Video Transcription

Video Summary

The panel session focused on advanced treatments for complex rotator cuff (RC) injuries, emphasizing biologic augmentation, tendon transfers, superior capsule reconstruction (SCR), and reverse shoulder arthroplasty (RSA), alongside emerging solutions like subacromial balloon spacers.<br /><br />Dr. Michael O’Brien discussed criteria for biologic augmentation during rotator cuff repair, using collagen implants to enhance biology in revisions or at-risk primary repairs, and dermal allografts to add mechanical strength in cases of atrophic tendon and multiple surgeries. Case studies showed effective augmentation improving healing rates up to 96% in large tears and revisions.<br /><br />Dr. Brian Cole addressed biologics, explaining that rotator cuff disease is largely degenerative. He highlighted the significance of patient-specific biological factors using the Rohy Healing Index, and reviewed evidence supporting biologic scaffolds, PRP (especially leukocyte-poor), and bone marrow aspirate concentrate (BMAC) in improving tendon healing and function, with economic analyses forthcoming.<br /><br />Dr. Grant Geraguse presented lower trapezius tendon transfers (LTT), particularly for irreparable posterior cuff tears with external rotation deficits, noting it has biomechanical advantages over latissimus transfers but requires Achilles allograft to lengthen the tendon. LTT is reserved for patients with functional muscle and absence of arthritis.<br /><br />Dr. J.T. Tokish outlined SCR indications, emphasizing distinguishing functional versus non-functional pseudoparalysis, the presence of muscle viability, and the need for precise anchor placement and graft incorporation for success. He promoted SCR for younger patients with massive tears but intact muscle quality.<br /><br />Dr. Brian Hartzell critically assessed RSA, cautioning against its overuse ("reverse is not a panacea"), highlighting complication risks and advocating joint-preserving procedures when possible, supported by mid-to-long-term data.<br /><br />Dr. Joe Aboud reviewed subacromial balloon spacers as a minimally invasive, temporary solution demonstrating improved outcomes mostly in patients >65 years. While easy to implant and remove, evidence of long-term benefit remains limited.<br /><br />Case discussions emphasized individualized approaches—considering tendon quality, patient age, muscle viability, and goals—to select between repair, augmentation, SCR, tendon transfer, balloon spacer, or RSA. Biologic augmentations offer promise but require careful patient selection and cost considerations. Tendon transfers and SCR address specific functional deficits, while reverse arthroplasty remains a salvage option for advanced disease. Balloon spacers present a low-risk adjunct, with ongoing studies on durability. Overall, multimodal treatment remains essential for complex rotator cuff pathology.

Asset Caption

Moderators: Vani Sabesan, M.D., Paul E. Caldwell, M.D., FAANA

Keywords

rotator cuff injuries

biologic augmentation

tendon transfers

superior capsule reconstruction

reverse shoulder arthroplasty

subacromial balloon spacers

collagen implants

Rohy Healing Index

lower trapezius tendon transfer

Achilles allograft