Specialized Shoulder Preservation Techniques for Significant Cuff Tears in Active Adults
Shoulder reconstructive surgeons, S Ashfaq Hasan, MD and Mohit Gilotra, MD, both associate professors of orthopaedics at the University of Maryland School of Medicine, utilize innovative techniques to repair massive rotator cuff tears in middle-aged, active adults. Although technically demanding, these breakthrough treatments help to preserve the shoulder for patients whose rotator cuff tears are beyond repair, and who are not joint replacement candidates due to age and activity level.
Superior Capsule Reconstruction
Superior Capsule Reconstruction is a Japanese technique that rebuilds rotator cuff characteristics for supraspinatus tendon tears. In Japan, surgeons reconstruct the cuff using thigh IT band; in the United States, however, dermal skin allografts are used.
While post-surgical pain relief compares similarly to joint replacement, the SCR boasts a better recovery than an average cuff repair. This is especially important for active patients under age 60, as they can drive soon after the minimally-invasive arthroscopic procedure, build greater strength and motion than joint replacement, and SCR demonstrates a considerably lower complication rate.
The recovery time is similar to a traditional joint replacement – four months, with two months of physical therapy; however unlike joint replacement, there are no lifting restrictions for SCR patients post-recovery, and they can regain strength.
Similarly to SCR, Trapezius Transfer is an alternative to joint replacement for substantial cuff tears in patients under age 60. This particular shoulder preservation technique treats infraspinatus tendon tears by utilizing the bottom of the trapezius muscle to reconstruct the rotator cuff. This practice is analogous to the former method of using the latissimus muscle to recreate the rotator cuff.
Trapezius Transfer is most beneficial to patients who need to gain and employ great strength. This includes younger, active adults with hobbies such as bodybuilding and gardening, or careers as assembly line workers, landscapers, and jobs involving loading and unloading heavy items. Recovery can be longer than traditional joint replacement for massive cuff tears, but pain relief is achieved with patients relying on non-narcotic therapies immediately following surgery.
The decision about which of these innovative shoulder preservation techniques to proceed with depends on the patient's goals, activity level, and X-ray and MRI results.
University of Maryland is one of ten medical centers nationwide, and one of only two in the region to be involved in a study by the American Shoulder and Elbow Society to evaluate the efficacy of these preservation techniques. In 2018, University of Maryland orthopaedic surgeons won the prestigious Charles S. Neer Award for their study findings of preoperative application of Benzoyl Peroxide to prevent delayed infection in shoulder surgery and surgical wound contamination.
University of Maryland orthopaedic surgeons are board certified, fellowship-trained, and Shock Trauma credentialed. Both Dr. Hasan and Dr. Gilotra are fellowship-trained in advanced shoulder and elbow reconstruction. As part of an academic medical center, they are heavily involved in research and teaching, in addition to clinical care.
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