Controversies in the Use of Grafts and Patches for Rotator Cuff Surgery: Augmentation, Interposition, Superior Capsule Reconstruction and Bio-inductive Scaffolds (AANA19)-Massive Rotator Cuff Tears_ An Arthroscopic Treatment Option Using Acellular Human Dermal Matrix-Dr. Mark H. Getelman, M.D.

Massive Rotator Cuff Tears_ An Arthroscopic Treatment Option Using Acellular Human Dermal Matrix-Dr. Mark H. Getelman, M.D.

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Video Transcription

Video Summary

This transcript discusses the complex case of a 71-year-old active woman with recurrent left shoulder pain and prior rotator cuff repair. The panel analyzes her failed repair, noting suboptimal anchor placement causing excessive tension. Imaging shows a massive cuff tear, with some preserved muscle quality and no severe arthritis. Treatment options include injections, physical therapy, superior capsule reconstruction (SCR), dermal allograft augmentation, partial repair, or reverse shoulder arthroplasty (reverse). The patient, however, declines reverse surgery, wanting to remain active. The experts debate surgical techniques, including graft orientation (fuzzy/dermal side down for healing), combined repair with SCR ("sandwich" technique), capsular release to improve humeral head reduction, and postoperative pain management strategies. They emphasize avoiding corticosteroid injections before surgery due to increased failure risks and discuss the limited benefit of liposomal bupivacaine. Ultimately, a revision rotator cuff repair augmented with a dermal graft SCR was performed, aiming to restore function while respecting the patient's activity goals.

Keywords

rotator cuff repair

shoulder pain

superior capsule reconstruction

dermal allograft augmentation

reverse shoulder arthroplasty

postoperative pain management