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Speaker discusses options for treatment of large, massive rotator cuff tears
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WAIKOLOA, Hawaii — In a Facebook Live event hosted at Orthopedics Today Hawaii, John M. Tokish, MD, discussed ways to treat large or massive rotator cuff tears.
Tokish noted it is important to take a look at the anatomy of a large or massive rotator cuff tear and to not panic.
“Sometimes [big tears] are not as bad as they would seem,” Tokish said. “Recognize the tear, figure out how to get it back to the edge and a lot of times, those are repairable.”
He also said surgeons experiencing failure or tension after a release can reinforce the graft or try a different technology. Highly active patients with tendon loss and who have high-quality muscle can be repaired with interposition and superior capsular reconstruction, according to Tokish.
“In my hands, I think the superior capsular reconstruction has changed my practice in this regard,” Tokish said. “It does a wonderful job of spanning that gap. Even very large tears, we can oftentimes bring back and restore the continuity of the cuff muscular tendinous junction, as well as the tendon bone junction interface.”
He added surgeons should be cautious about performing superior capsular reconstruction in patients with advanced arthritis and recommended a reverse shoulder arthroplasty in patients who are older, more sedentary and have more arthritis and pain. Tokish also noted that surgeons should be aware of grade 4 Goutallier changes in the infraspinatus and supraspinatus.
“Even if you are able to re-establish that spanning, I worry that we are not going to get good functional motion back and, in those cases, that is the one time I think maybe sometimes we need to go to tendon transfer,” Tokish said.
However, even if the subscapularis needs to be reinforced, Tokish said if it is repairable then “we are in pretty good shape.” Tokish noted one trick he has learned is to always incorporate a partial repair into the superior capsular reconstruction.
“We want to get that cuff, whatever remnant you have left, you want to reattach that to the patch so that whatever muscle they have left firing can be transferred as a functional unit to help give those patients function,” he said. – by Casey Tingle
Reference:
VIDEO: Romeo, Tokish discuss options for the repair of large, massive rotator cuff tears. Available at: www.healio.com/orthopedics/shoulder-elbow/news/online/%7Bec544028-1dd6-4cf3-9528-d15b11687752%7D/video-romeo-tokish-discuss-options-for-the-repair-of-large-massive-rotator-cuff-tears. Accessed Jan. 15, 2019.
Disclosure: Tokish reports he is an IP rights/patent holder for Arthrex; receives consulting fees from Arthrex and DePuy, Johnson & Johnson; and is on the speakers bureau for Arthrex and DePuy, Johnson & Johnson.