APEX Shoulder Mastering Surgical Techniques for Clinical Success-Shoulder Irreparable Cuff

Video Transcription

Video Summary

The discussion focuses on irreparable rotator cuff tears, presenting patient cases and surgical treatment options. A 56-year-old retired Marine with a recurrent tear and significant infraspinatus atrophy underwent a lower trapezius tendon transfer with an Achilles allograft, showing improved function at 6 months post-op. This procedure is favored over reverse shoulder arthroplasty or superior capsule reconstruction (SCR) when the teres minor is intact, as it better restores external rotation. Patient compliance with prolonged immobilization and rehab is critical for success. Another case involved a 65-year-old man with a chronic tear and pain but preserved motion; he underwent arthroscopic debridement, biceps tendon transfer, and partial repair, resulting in pain relief but persistent weakness. The panel highlighted the importance of individualized treatment considering muscle quality, patient expectations, and the Rohy score. Alternatives like subacromial balloon spacers and bridging grafts have niche roles but tendon transfers remain a mainstay for irreparable posterior cuff tears. Overall, patient education on realistic outcomes is emphasized.

Asset Caption

Moderator: Michael O’Brien, M.D.
Panel: William Ciccone, M.D., Robert Hartzler, M.D., Theodore Shybut, M.D.

Keywords

irreparable rotator cuff tears

lower trapezius tendon transfer

Achilles allograft

reverse shoulder arthroplasty

superior capsule reconstruction

patient compliance