July 24, 2018
In this article, the experts at Beacon Orthopaedics explore the range of symptoms involved with rotator cuff tears, the necessary treatments to relieve patient symptoms—and, more specifically, the benefits of pursuing Superior Capsular Reconstruction using allografts to repair irreparable rotator cuff tears versus the more common treatment options.
The Rotator Cuff and Shoulder Stability
Your shoulder joint is the most mobile joint in your body. However, no matter the level of mobility within the shoulder, its lack of strong ligaments leaves your shoulder reliant on its surrounding muscles to maintain stability—in which your rotator cuff plays a critical role.
Rotator cuff tears are common, at times hard to detect, and among the more difficult injuries to treat.
When it comes to properly treating rotator cuff tears, physicians make their diagnosis on a per-patient basis. Symptoms vary between patients:
- Some experience severe shoulder weakness and are unable to raise their arm
- Some experience pain over the top of the shoulder but can still raise their arm
- Some experience no pain and experience functional limitations of the arm
- Some experience pain that descends down the arm—sometimes even down to the elbow
However, once diagnosis is reached, the path to recovery is still uncertain. In most cases, physicians first suggest non-surgical treatments for rotator cuff repairs, such as physical therapy, anti-inflammatory medications, or cortisone injections, because surgical treatments have a higher likelihood of either causing more damage to the torn tendons, or need of a revision surgery over time.
Before surgical treatments are planned for patients, your physician must discuss the following to be sure surgery is the best option:
- Your past and current symptoms
- Damages due to your rotator cuff tear
- Size and location of your tear
- Your activity level
- And all other treatments that have been attempted in your case
Solutions for Irreparable Rotator Cuff Tears
Shoulder functionality with an irreparable rotator cuff tear ranges from little to none.
Rotator cuff injuries—where the tendons at the ends of the rotator cuff muscles become torn and result in pain and limited shoulder mobility—frequently occur following a trauma to the shoulder joint or through general wear and tear on tendons within the rotator cuff over time.
If the tendons tear chronically, the connected muscle involutes and is replaced by fat and scar tissue, making the muscle too stiff to contract with enough force to rotate the humeral head on the socket effectively—resulting in restricted shoulder mobility.
When conservative measures fail and patients continue to experience pain, surgery is the next logical step. However, patients diagnosed with irreparable rotator cuff tears are typically met with very limited options for treatment.
Surgical procedures such as reverse shoulder replacement—where the ball and socket structure of the shoulder joint is reversed—don’t fully address the problem faced by patients with irreparable rotator cuff tears. Even though this procedure reverses which muscles support shoulder stability, shifting from the rotator cuff muscles to the deltoid muscles, this method often leads to required revision surgeries down the line for some patients.
Arthroscopic SCR using Allografts as an Alternative Solution for Irreparable Tears
Dr. Rolf at Beacon Orthopaedics, performs arthroscopic superior capsular reconstructions using allografts as an alternative surgical procedure to aid in shoulder stability and improve shoulder function despite the occurrence of irreparable rotator cuff tears.
Superior Capsular Reconstruction (SCR)—an arthroscopic procedure where a graft is secured to the glenoid and greater tuberosity—makes use of allografts to strengthen and reconstruct the superior capsule to ensure that patients regain the ability to maintain the natural mechanics of the shoulder.
What is an Allograft?
An allograft is tissue taken from one person for transplantation into another—including bone, tendons, ligaments, skin and heart valves. Donation is always voluntary and requires consent, from either the donor in question before death or the donor’s family post-mortem. After authorized consent is obtained, potential donors are thoroughly screened for risk factors and medical conditions that would rule out donation.
Procedures where allografts are used:
- Shoulder repair
- ACL repair
- Joint reconstruction in the knee and ankle
- Meniscal replacement
- Reconstruction due to cancer or trauma
- Ridge augmentation in dental procedures
- Spinal fusion
- Urological procedures
Why Use Allografts?
The preference of allografts over autografts is the ability to keep the treatment limited to one surgery versus requiring two. When surgeons use an allograft, it is already pre-screened for risk factors, so there is no need to retrieve a graft from another part of your body, and get that autograft ready to use for your procedure.
When receiving an allograft implant, be sure to ask your surgeon about tissue preparation and sterilization.
Currently Experiencing Shoulder Pain or Instability?
Consult a physician now. Dr. Robert Rolf, one of the physicians at Beacon Orthopaedics and Sports Medicine, received extensive training in advanced arthroscopic techniques for shoulder instability and rotator cuff tears and has world class experience in complex shoulder reconstructive procedures including tendon transfers, shoulder replacement, and reverse shoulder replacement procedures. If you are reading this article to figure out if you might have a rotator cuff tear, or are unsure of which treatment method might be best for the specific symptoms you’re experiencing, scheduling an appointment with Dr. Rolf will provide more information for your particular case.