Controversies in the Use of Grafts and Patches for Rotator Cuff Surgery: Augmentation, Interposition, Superior Capsule Reconstruction and Bio-inductive Scaffolds (AANA19)-Case Study_ Controversies in the Use of Grafts and Patches for Rotator Cuff Surgery_ Augmentation, Interposition, Superior Capsule Reconstruction and Bio-inductive Scaffolds-Dr. Richard K.N. Ryu, M.D.

Case Study_ Controversies in the Use of Grafts and Patches for Rotator Cuff Surgery_ Augmentation, Interposition, Superior Capsule Reconstruction and Bio-inductive Scaffolds-Dr. Richard K.N. Ryu, M.D.

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Video Transcription

Video Summary

The discussion centers around complex rotator cuff tear management, emphasizing precise diagnosis, particularly distinguishing pseudoparalysis from pseudoparasis, and the importance of assessing active vs. passive motion. The panel evaluates a challenging case of a 54-year-old firefighter with a massive rotator cuff tear and considers surgical repair options, including subscapularis repair and tendon transfers. The use of biologics and scaffolds, particularly a bovine collagen "scaffold" with no mechanical strength, is highlighted as an adjunct to enhance healing by promoting tissue growth. The distinction between mechanical grafts and biologics like platelet-rich plasma (PRP) and stem cells is discussed, noting varying evidence and regulatory challenges. PRP’s efficacy remains debated, while stem cell therapies show promise but lack consistent clinical proof. The importance of microfracturing the tuberosity to stimulate marrow-derived healing factors is noted. Overall, the goal is to restore anatomy primarily via repair, with biologics serving as evolving adjuncts to improve outcomes in difficult rotator cuff repairs.

Keywords

rotator cuff tear

pseudoparalysis diagnosis

surgical repair options

biologics in tendon repair

platelet-rich plasma PRP

stem cell therapy