2024 AANA/ISAKOS Specialty Day All-Access Pass-Case Panel Discussion: Massive Rotator Cuff Tears: So Many Options!

Video Transcription

Video Summary

The panel discussed complex rotator cuff tear cases, exploring surgical options and challenges. A 56-year-old laborer with a massive, chronic tear underwent surgical repair augmented by biceps tendon transfer and dermal grafting, achieving good functional recovery despite risk factors like smoking. The debate covered MRI timing, surgical techniques including interval slides, and biological augmentations like PRP, with consensus favoring repair over nonoperative management or reverse shoulder arthroplasty in younger active patients. A second case of a 60-year-old man with chronic tear and fatty infiltration highlighted treatment dilemmas, partial repair and debridement favored over extensive reconstructions. The group emphasized the importance of updated imaging, patient counseling on healing risks, and tailoring surgery to function and pain. Popularity and evolving indications for subacromial balloon spacers—used as pain-relief spacers in irreparable tears with preserved motion—were discussed, with promising early outcomes in select patients, especially older active individuals unwilling to undergo replacement.

Asset Caption

Mark H. Getelman, M.D., FAANA, Ian K.Y. Lo, M.D., F.R.C.S.C., Michael Haessam Amini, M.D., Sara L. Edwards, M.D., Albert Lin, M.D., Ettore Taverna, M.D.

Keywords

rotator cuff tear

surgical repair

biceps tendon transfer

dermal grafting

MRI timing

subacromial balloon spacers