Optimal Non-Arthroplasty Management of Massive Irreparable Rotator Cuff Tears: A Case-Based Approach (2025 Annual Meeting)-Optimal Non-Arthroplasty Management of Massive Irreparable Rotator Cuff Tears: A Case-Based Approach

Video Transcription

Video Summary

This ICL session focused on non-arthroplasty treatment options for irreparable massive rotator cuff tears, featuring experts Sara Edwards, Eric Wagner, Ivan Wong, and Albert Lin as moderator. The panel explored multiple advanced and established surgical strategies highlighting their indications, outcomes, and limitations.<br /><br />Dr. Edwards discussed the resurgence of superior capsule reconstruction (SCR) using the biceps tendon as a graft to stabilize the shoulder, showing promising biomechanical support and clinical improvements in pain and motion. She emphasized its simplicity, cost-effectiveness, and durability compared to traditional SCR with allografts.<br /><br />Dr. Lin advocated for partial rotator cuff repair combined with biceps tenodesis or debridement as a cost-effective gold standard, underscoring consistent, good functional outcomes despite high re-tear rates. He detailed patient selection, cautioning against premature reverse shoulder arthroplasty in patients with preserved motion and minimal arthritis.<br /><br />Dr. Wong presented bridging allograft reconstruction techniques aimed at restoring the rotator cable and tendon anatomy, demonstrating superior healing rates and preservation of muscle quality compared to partial repair alone. He highlighted the importance of patient selection based on muscle fatty infiltration and discussed surgical technical nuances like suture management.<br /><br />Dr. Wagner focused on tendon transfers, particularly the lower trapezius transfer, to augment partial repair in patients with poor muscle quality and weakness, showing improved biomechanics and functional outcomes compared to latissimus dorsi transfer or SCR in these scenarios.<br /><br />They collectively stressed individualized treatment algorithms based on patient age, functional status, muscle quality, and goals, balancing complexity, durability, and cost. The panel agreed that more high-quality comparative studies are needed to clarify the optimal indications and long-term benefits of these evolving techniques versus simpler repairs or reverse arthroplasty.

Asset Caption

Albert Lin, M.D. | Ivan H. Wong, M.D., FAANA | Sara L. Edwards, M.D. | Eric R. Wagner, M.D., M.S.

Keywords

irreparable massive rotator cuff tears

non-arthroplasty treatment

superior capsule reconstruction

biceps tendon graft

partial rotator cuff repair

biceps tenodesis

bridging allograft reconstruction

rotator cable restoration

tendon transfers

lower trapezius transfer

treatment algorithms