New approach offers minimally invasive repair for rotator cuff injuries

An innovative technique to treat irreparable rotator cuffs is making its way to the United States from Japan, offering patients the option to undergo a minimally invasive procedure with less recovery time than standard treatment. Different from traditional shoulder replacement surgery, superior capsule reconstruction is performed in less than an hour under regional anesthesia. The outpatient procedure also requires minimal incisions to insert an allograft from cadaver tissue.

Dr. Joshua Dines, an orthopedic surgeon specializing in sports medicine and shoulder surgery at the Hospital for Special Surgery, in New York, said some patients report feeling immediate pain relief after electing to undergo the superior capsule reconstruction procedure.

“They seem to not be in much pain,” he told “By four to six weeks they have full motion.” By contrast, reverse shoulder replacement requires general anesthesia, invasive surgery and a multi-day hospital stay. Patients are then advised against using their arm for the first four to six weeks, and they likely use a sling.

Despite these initial results, Dines instructs his patients to follow traditional rotator cuff repair therapy, meaning they can expect a full recovery in six months post-surgery. The reason Dines hesitates to push his patients toward the newer procedure is using the allograft requires giving the body time to transform foreign tissue into its own, he said.

“[Patients] may feel very good right away, but your body is turning the graft into your own tissue. There’s probably a period of time where this cell patch gets a little weaker before it gets stronger again,” he said. “I tell patients to go slow.”

The rotator cuff is located in the shoulder area and is constructed of muscles and tendons. It stabilizes the shoulder and helps it move. An injury or tear to the rotator cuff can occur during a fall, repeated overhead motion or ageing.

Prospective patients for this new procedure are those
with irreparable rotator cuff tears. These can occur in patients who have never had prior surgery, and those who have had failed repairs. A particular benefit may be in those looking to delay shoulder replacement and in young, active patients with irreparable tears that are looking to stay involved in sports and
manual labor.

“When someone comes in with a rotator cuff tear that I or a colleague deem irreparable and you tell them they need a shoulder replacement, that seems barbaric,” he said. “It’s hard for them, a lot of the time, to grasp. This [option] makes it more palatable for the patient in terms of options.”

Another perk, Dines said, is that rotator cuff repairs through reverse shoulder replacement may last only 10 years, but once it fails, there is not much left for a surgeon to do. In traditional repairs, surgeons put the ball where the socket once was, and the socket where the ball was. Once it fails, it can’t be repeated.

“Even if I get just a few years, that’s great,” Dines said. “If you can delay a replacement for five years, probably by that time we’ll have developed even more procedures to delay it.”

Dines said the procedure continues to advance and adapt as popularity spreads, explaining that in Japan, the Food and Drug Administration (FDA)-approved allograft approach is banned, meaning patients must use tissue from their thigh, which causes additional pain and recovery time. The U.S.-adapted version has already eliminated the need for the extra recovery time.

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Aside from general risks associated with an arthroscopic procedure, Dines said the worst-case scenario for patients is that the procedure failed. Even if that happens, Dines said, there’s no bridges burned and patients are back to where they started. However, while more time will have to pass before conclusions can be drawn, all nine of Dines’ patients are recovering well, he said.

“It’s very low risk with potentially high rewards,” he said.