Our conversation picks back up with an article published in the December 2020 issue of Current Reviews in Musculoskeletal Medicine titled “Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction.” Authored by our guest today, this review article summarizes the biomechanical properties and functional outcomes of superior capsular reconstruction or “SCR” for treatment of massive irreparable rotator cuff tears. The authors report that SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff – particularly posterior – improves stability. Patient selection is key, with the ideal patient being younger than 70 and a healthy nonsmoker with an irreparable posterior cuff tear in the absence of glenohumeral arthritis and a functioning or repairable subscapularis.

We finish up our discussion today with the publication titled “Latissimus dorsi transfer or lower trapezius transfer: a treatment algorithm for irreparable posterosuperior rotator cuff tears muscles transfers in posterosuperior rotator cuff tears.” Laurent Lafosse and team compared two tendon transfer options for irreparable posterior-superior rotator cuff tears with rotational deficiency – the latissimus dorsi transfer and the lower trapezius transfer. They found that active motion, pain scores and function were improved in both groups with a low failure and revision rate. The authors suggest that lower trapezius transfer better restores external rotation at the side while latissimus dorsi transfer may be a better option for restoration of external rotation and abduction.

On today’s episode we’re focusing on challenging rotator cuff pathology with Dr. Patrick Denard, an orthopedic shoulder surgeon at the Oregon Shoulder Institute. We have some great articles for you that contribute well to our conversation on the treatment options for massive reparable, as well as irreparable, rotator cuff injuries. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an expert opinion article from the July 2022 issue of Arthroscopy titled “Graft Augmentation of Repairable Rotator Cuff Tears: An Algorithmic Approach Based on Healing Rates.” Authored by our guest today, this article provides an algorithm for tissue augmentation of rotator cuff repairs based on the current available evidence regarding rotator cuff healing. The authors recommend using a Rotator Cuff Healing Index or “ROHI” cutoff of greater than or equal to 7 to select for the use of tissue augmentation, as the healing rate is 66% at 6 points but decreases substantially to 38% at 7 points.

Then, from the May 2019 issue of AJSM, we review an article titled “Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis.” The authors concluded that graft augmentation provided significantly lower retear rates and higher ASES scores compared with cuff repair alone. With regards to graft choice for augmentation, the highest rates of healing, as demonstrated by repair integrity on imaging, were shown for allograft at 82% compared to xenograft at 68%. Nonaugmented repairs had a healing rate of only 49%.

We finish up our discussion today with the publication titled “Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.” This level III retrospective study published in the August issue of JBJS this year, sought to determine the relationship between preoperative nutritional status, using the Geriatric Nutritional Risk Index or “GNRI”, and rotator cuff retears after arthroscopic repair in patients 65 years of age and older. The authors found that poor pre-op nutrition, as exhibited by a GNRI less than 103, was an independent risk factor for a cuff retear at 2 years post-op.

We are joined today by Dr. Patrick Denard, a board-certified orthopedic shoulder surgeon and Director of the Oregon Shoulder Institute. He is also the Director of the Oregon Shoulder Fellowship and Associate Professor of Orthopedic Surgery at Washington Status University School of Medicine. Dr. Denard is the Chairman and Founder of the Pinnacle Shoulder meeting and a reviewer for the Journal of Shoulder and Elbow surgery. He has published and lectured extensively on the topic of rotator cuff pathology, so we are very excited to have him join our discussion today.

In this episode, we’re going to continue our discussion with Dr. Aaron Krych and focus on surgical advancements to address meniscus extrusion and optimize postoperative outcomes for patients.

Our conversation picks back up with an article published last month in Arthroscopy Techniques titled “Arthroscopic Centralization of the Extruded Meniscus With Posterior Root Tear: A Technique Using Meniscotibial Ligament Fixation.” Most meniscus centralization techniques involved anchoring the meniscus body directly to the tibia, which can limit the normal anatomic motion of the meniscus. Dr. Krych and his team described a novel technique for meniscus centralization that maintains natural meniscal motion by utilizing the meniscotibial ligaments to centralize the meniscus body.

Then, from the May 2024 issue of Arthroscopy, we review an article titled “Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up.” This case series concluded that patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant improvements in pain, function, satisfaction and quality of life. Additionally, there was no evidence of significant arthritic progression on postoperative imaging. No patients underwent revision meniscus surgery or total knee arthroplasty.