Controversies in the Use of Grafts and Patches in Rotator Cuff Surgery: Augmentation, Interposition, Reinforcement, Superior Capsular Reconstruction and Bio-Inductive Scaffolds (2021 Annual Meeting)-Controversies in the Use of Grafts and Patches in Rotator Cuff Surgery: Augmentation, Interposition, Reinforcement, Superior Capsular Reconstruction, and Bio-Inductive Scaffolds-Tokish 2

Controversies in the Use of Grafts and Patches in Rotator Cuff Surgery: Augmentation, Interposition, Reinforcement, Superior Capsular Reconstruction, and Bio-Inductive Scaffolds-Tokish 2

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Video Summary

The discussion centers on managing a young patient with high Hamada shoulder deformity. Reverse shoulder arthroplasty in patients under 60 shows high failure rates, mainly due to pain and mechanical issues from high activity levels. Alternatives include superior capsular reconstruction (SCR), tendon transfers, or biological spacers, with success depending on muscle quality. Thicker grafts—especially autografts—and proper graft orientation improve outcomes. The presented "SCR plus" technique uses doubled graft thickness and acromion resurfacing to enhance biomechanics and provide lasting support. However, SCR involves long rehab and variable healing rates. Overall, treatment choice hinges on age, muscle function, and joint degeneration degree.

Asset Caption

Dr. John Tokish

Keywords

Hamada shoulder deformity

reverse shoulder arthroplasty failure

superior capsular reconstruction

tendon transfers

SCR plus technique