Course Lecture Pearls: Arthroscopic Shoulder Solutions-Massive Rotator Cuff Tears-Joseph C. Tauro, M.D.

Video Transcription

Video Summary

The speaker discusses challenges and advancements in repairing massive rotator cuff tears, emphasizing that "massive" varies in definition. Early in their careers, surgeons often abandoned large tears for open surgeries, but now arthroscopic repair techniques, including soft tissue releases and interval releases, improve tendon mobility and repair success. They stress understanding tear patterns and associated instability—anterior with subscapularis tears, posterior with supraspinatus and infraspinatus tears—and the importance of restoring scapular stability. Nonoperative treatments, like injections and physical therapy, are viable for older patients, while reverse arthroplasty suits certain severe cases with functional infraspinatus. The speaker cautions against overtensioning repairs and highlights the role of releases to avoid failures. They demonstrate a single-row repair technique using anchors for adequate tendon reattachment, advising preservation of the coracohumeral ligament during subacromial decompression. The talk underscores that with proper techniques, many massive tears thought irreparable can be fixed arthroscopically, delaying or avoiding more invasive surgery.

Keywords

massive rotator cuff tears

arthroscopic repair

tendon mobility

scapular stability

reverse arthroplasty