APEX Shoulder Mastering Surgical Techniques for Clinical Success-Shoulder Irreparable Cuff

Video Transcription

Video Summary

The panel discusses “irreparable” rotator cuff tears—tears not fully repairable—and how treatment depends on function, expectations, and tissue quality. Case 1 is a highly active 56-year-old with recurrent post-repair tear, severe external rotation lag, major infraspinatus atrophy/retraction to the glenoid, but a robust teres minor and minimal arthritis. The group favors a lower trapezius tendon transfer with Achilles allograft (plus subscap repair if needed) to restore external rotation and recenter the humeral head, emphasizing strict, prolonged immobilization and realistic strength expectations. They note alternatives (SCR, bridging grafts, balloon, reverse arthroplasty) and discuss using factors like age, tear size, and atrophy (e.g., “Rohy” score) rather than strict cutoffs. Case 2 is a 65-year-old with chronic pain and weakness but good motion; surgeons consider arthroscopy with partial repair and biceps “posting/transfer” to the tuberosity as a biologic, inexpensive augment to improve pain and function while delaying reverse arthroplasty.

Asset Caption

Moderator: Michael O’Brien, M.D.
Panel: William Ciccone, M.D., Robert Hartzler, M.D., Theodore Shybut, M.D.

Keywords

irreparable rotator cuff tear

lower trapezius tendon transfer

Achilles tendon allograft

external rotation lag and infraspinatus atrophy

superior capsular reconstruction alternatives

partial rotator cuff repair with biceps tenodesis/transfer