2025 AANA/ASES Specialty Day All-Access Pass-AANA/ASES Session II: Rotator Cuff

Video Transcription

Video Summary

The session focused on managing massive rotator cuff tears, particularly in 60-year-old patients. Dr. Joe Abood advocated for the in-space balloon device as an option for massive irreparable rotator cuff tears with specific criteria: minimal osteoarthritis, ability to forward elevate to 90 degrees, intact subscapularis, and failed conservative management. His data on 192 patients showed significant improvements in pain and function at one year, noting the balloon is absorbable, decreases invasiveness, and accelerates rehab without permanent burden, serving as a beneficial bridge or augmentation.<br /><br />Dr. Eric Wagner emphasized the lower trapezius transfer (LTT) for patients with irreparable tears and muscle fatty infiltration, highlighting its biomechanical advantage in restoring scapulohumeral rhythm and function. Though surgery has a steep learning curve and modest functional gains, LTT replaces deficient muscle dynamically and is combined with partial cuff repair for better outcomes.<br /><br />Dr. Bob Burks discussed reverse shoulder arthroplasty (RSA) as the most reliable choice, especially for irreparable tears with pseudoparalysis. RSA restores elevation but poses risks including loss of range of motion, acromial stress fractures, and instability, highlighting the need for patient-specific counseling.<br /><br />Dr. Larry Field presented the biceps tendon superior capsular reconstruction (BioSCR) technique as a simple, cheap, and effective augmentation, using the biceps tendon transposed to support cuff repair. This biologically viable autograft was shown to improve outcomes and reduce retear rates without significant biceps pain.<br /><br />Dr. Brian Cole reviewed allograft patch augmentation, noting that despite advances, rotator cuff repair failures remain common, often due to degeneration and poor biology. Allografts enhance repair strength, reduce retears, and are cost-effective, especially in large or revision tears with compromised healing potential.<br /><br />Panel discussions emphasized individualized treatment based on patient age, function, tear reparability, and comorbidities. Partial repairs combined with augmentation (balloon, biceps, or patches) were favored for active patients avoiding extensive surgeries. Reverse arthroplasty remains a mainstay for pseudoparalytic shoulders. Capsular releases and preserving or utilizing the biceps tendon were common technical points. Overall, the session underscored tailoring rotator cuff tear management using augmentation, transfers, or arthroplasty based on patient and tear characteristics.

Asset Caption

Moderators: Mark H. Getelman, M.D., FAANA, Melissa A. Wright, M.D.
Faculty: Joseph A. Abboud, M.D., Eric R. Wagner, M.D., M.S., Robert Z. Tashjian, M.D., Larry D. Field, M.D., FAANA, Brian J. Cole, M.D., M.B.A., FAANA

Keywords

massive rotator cuff tears

in-space balloon device

lower trapezius transfer

reverse shoulder arthroplasty

biceps tendon superior capsular reconstruction

allograft patch augmentation

irreparable rotator cuff tears

rotator cuff repair augmentation

pseudoparalysis

patient-specific rotator cuff management