AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Case Presentation

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This presentation by Dr. Richard K.N. Ryu addresses management strategies for massive rotator cuff tears (MRCT), defined as tears involving two or more tendons and exceeding 4-5 cm. MRCT patients may present compensated with full range of motion but weakness or decompensated with pseudoparalysis and pain. Treatment options vary from conservative measures to advanced surgical interventions including partial repair, repair with extracellular matrix (ECM) augmentation or bio-inductive implants, ECM interposition/bridging grafts, superior capsule reconstruction (SCR), tendon transfers (latissimus dorsi/lower trapezius), reverse shoulder arthroplasty, subacromial spacers, and debridement.<br /><br />Cases illustrated key approaches: tendon-to-tendon repair with augmentation (“rip-stop” technique), interposition ECM graft bridging failed repairs to restore superior translation control, and SCR using dermal allografts particularly in younger, active patients with intact or reparable subscapularis and minimal osteoarthritis. The biomechanical rationale is supported by research showing grafts spanning from the glenoid to tuberosity restore shoulder stability by controlling superior humeral translation. Bio-inductive scaffolds promote tendon healing by stimulating tissue ingrowth but do not provide mechanical support.<br /><br />Subacromial spacers, absorbable devices placed in the bursa, demonstrated improved range of motion and functional scores in irreparable cuff tears in older patients.<br /><br />Conclusions emphasize the evolving indications for SCR, favoring younger, active patients with preserved external rotation and minimal joint degeneration. Augmentation, interposition, and SCR are technically demanding but may provide superior outcomes. Dermal allograft currently represents the optimal graft choice for SCR.<br /><br />This summary reflects contemporary surgical modalities, their indications, biomechanical basis, and clinical outcomes in managing complex massive rotator cuff pathology.

Asset Caption

Dr. Richard K.N. Ryu, M.D.

Keywords

massive rotator cuff tears

MRCT

rotator cuff repair

extracellular matrix augmentation

superior capsule reconstruction

tendon transfers

reverse shoulder arthroplasty

subacromial spacers

dermal allografts

bio-inductive scaffolds