Does shoulder pain and loss of motion have you sidelined? Do you have a massive rotator cuff tear with severe pain and an inability to use your arm, but are too young for a shoulder replacement? At Midwest Orthopedic Specialty Hospital we have surgeons who can help you.
Patients with massive rotator cuff tears, or rotator cuff arthropathy, usually can’t lift up their arm in front of them or away from their side. They also complain of severe pain and a very poor quality of life. Typically these patients have an arm that acts almost paralyzed with lack of active motion at the shoulder due to the large tear of the rotator cuff and the associated change in the way the shoulder moves.
The typical patient presenting with massive rotator cuff tear is older and lives a more sedentary lifestyle. Most of these rotator cuff tears are degenerative, meaning they progress over time and ultimately retract or pull away from their normal attachment site on the ball of the shoulder. These rotator cuff tears become “atrophic,” or shrink irreversibly due to the muscle not being used for a long time. Treatment of this condition in older, less active patients is very predictable with a joint replacement procedure called the reverse total shoulder replacement. This is a replacement procedure where the shoulder joint is replaced with metal and plastic parts. The concern in younger more active patients is that these joint replacements typically wear out in 7-10 years if one is too young or active with it. Because of the limited lifespan of this replacement operation, it is generally felt among shoulder surgeons that the reverse shoulder replacement should be reserved for people over 70 years old with sedentary lifestyles.
Young, Active Patients
When a patient is too young for a reverse total shoulder replacement, and has a massive rotator cuff tear with atrophy, what can we do? Historically, options included arthroscopic procedures to “clean up” the shoulder, remove bone spurs and release tissue that might be causing decreased function and pain in the shoulder. In the active and physiologically young patient, reverse total shoulder arthroplasty is not considered an option due to concerns of the replacement wearing out too quickly. The revision of reverse shoulder replacement that wears out is very difficult, and very hard to predict, therefore, this procedure is considered a last resort for these patients.
A New Type of Arthroscopic Rotator Cuff Surgery
In 2013, Dr. Mihata from Japan introduced a new procedure to the world called the arthroscopic superior capsular reconstruction as a successful procedure treating massive, irreparable rotator cuff tear without performing a reverse shoulder replacement. The goal of this procedure is to restore shoulder motion by taking a soft tissue graft from patients’ legs and placing it into the area in which patients suffered tissue loss due to massive rotator cuff tears. This is an arthroscopic rotator cuff surgery (minimally invasive performed with a television camera placed through very small incisions) and showed excellent results in pain relief and in restoring movement of the shoulder that these patients typically lost with massive rotator cuff tears. In early outcome reports this procedure showed excellent clinical results in patients. More importantly, if this operation doesn’t last forever it can be easily changed to a reverse shoulder replacement when the patient is an acceptable candidate for that operation.
As this procedure has been introduced in the United States, a technique of arthroscopic superior capsular reconstruction with a piece of skin from an organ donor has been developed to make the need for graft harvest from the patient’s leg not necessary. This procedure has gained rapid momentum in the United States as reports of great outcomes among surgeons have been favorable and the surgeons at the Midwest Orthopedic Specialty Hospital have led this charge in the United States. At Midwest Orthopedic Specialty Hospital, we have the largest patient group in the country (more than 130 patients) with successful outcomes. We have over an 85% success rate in our first 90 shoulders treated with this procedure with at least one year follow- up.
The arthroscopic superior capsular reconstruction has helped our surgeons at Midwest Orthopedic Specialty Hospital provide patients with massive rotator cuff tears excellent pain relief and increased function without needing to perform a total joint replacement. We are very excited about this procedure and our ability to keep our most active patients in the game.