ICL 102: Orthobiologics in the Treatment of Rotator Cuff Pathology-Orthobiologics in the Treatment of Rotator Cuff Pathology

Video Transcription

Video Summary

The talk covers advanced orthopedic treatments focusing on platelet-rich plasma (PRP) therapy, stem cells, and surgical techniques for massive rotator cuff tears. PRP is categorized into leukocyte-poor (less inflammatory, suited for arthritis) and leukocyte-rich (more inflammatory, for tendon/ligament healing). The speaker shares clinical experience with PRP for partial rotator cuff tears and epicondylitis, noting positive MRI healing though acknowledging regulatory challenges and cost concerns. Stem cell treatments, like adipose-derived or bone marrow aspirate, face regulatory hurdles despite promise.<br /><br />For massive rotator cuff tears (>5 cm, involving multiple tendons with atrophy), treatment options include repair alone, repair plus patches, supracapsular reconstruction (SCR), or reverse shoulder arthroplasty. SCR, pioneered by Miyata, involves placing a thick dermal patch to hold the humeral head down, changing shoulder biomechanics, allowing residual rotator cuff to function better. The speaker details SCR surgical technique emphasizing careful anchor placement and postoperative care with immobilization and passive motion. Early results are promising but long-term outcomes remain uncertain.<br /><br />The discussion underscores individualized patient assessment—tear size, atrophy, function—to select optimal treatment. While reverse shoulders are effective for older, arthritic patients, SCR offers an option for younger, active patients with irreparable tears. The role of biological adjuncts like the biceps tendon is considered but deemed flexible. Overall, PRP and SCR represent evolving tools to improve outcomes in challenging rotator cuff pathology.

Keywords

platelet-rich plasma

PRP therapy

stem cell treatments

massive rotator cuff tears

suprascapular reconstruction

reverse shoulder arthroplasty

rotator cuff repair

biological adjuncts