New Surgery May Fix Tough-to-Treat Rotator Cuff Tears

Procedure could offer option for otherwise irreparable shoulder injury, surgeons say

Wednesday, July 26, 2017

TUESDAY, July 25, 2017 (HealthDay News) -- A new surgical procedure can help people with shoulder injuries once considered beyond repair, a small new study suggests.

Out of 100 patients who had the surgery in the study, all 26 of those who had played sports before the surgery were able to play sports again afterwards. Thirty-two patients who had jobs lifting heavy workloads were able to return completely to work. Another two -- a farmer and a manual worker -- were also able to return to work, but with reduced hours and reduced workloads.

The procedure is called arthroscopic superior capsule reconstruction (SCR) surgery. It was developed by Japanese surgeons to fix rotator cuff injuries once considered irreparable.

The rotator cuff is a group of muscles, tendons and ligaments that attach your arm to your shoulder. The rotator cuff helps you lift and rotate your arm, according to the American Academy of Orthopaedic Surgeons. Over time or with an injury, the rotator cuff can develop partial or complete tears.

"Around 30 percent of medium to large tears, and more than 80 percent of massive tears are irreparable in my patients," said study author Dr. Teruhisa Mihata. He is chief of shoulder and elbow surgery and sports medicine at Osaka Medical College in Japan.

In the past, Mihata said, if the two ends of the tear could no longer meet together, a rotator cuff injury was considered permanent.

But SCR surgery grafts a soft tissue "patch" from a cadaver that's placed over the top of the shoulder joint to substitute for the missing tendons, explained Dr. Evan Karas, who wasn't involved in the study, but who has been performing this surgery for about a year. In standard rotator cuff surgery, the goal is to repair the person's own tendons, he explained.

The average age of the study patients was 67, ranging in age from 43 to 82. The average follow-up time was four years.

Ninety-five out of 102 shoulders repaired didn't have additional problems, such as a re-tear in the rotator cuff. Pain and range-of-motion improved after surgery, according to Mihata.

Some of the sports that people were able to go back to included: golf, tennis, swimming, baseball, martial arts, yoga, skiing and mountain climbing.

"SCR is the surgical technique to restore shoulder stability and improve shoulder function with pain relief, without repairing the torn rotator cuff tendons," Mihata said.

Karas agreed that the surgery seems to be successful.

"There are studies now showing good-to-excellent two-year clinical results from SCR surgery. Longer-term studies are now being conducted to prove that the results are durable over time," he said.

This surgery gives patients an option they didn't have before, Karas added.

"I see many patients with chronic rotator cuff tears who have been told by other doctors that there is nothing else that can be done for their shoulder. This leaves them with the option of living with significant pain and disability," Karas said.

"Since we now have effective ways of treating these types of rotator cuff tears, I think the most important thing for people to know is that there is hope of eliminating pain and restoring function," he added. Karas is a shoulder surgeon and co-chief of orthopaedic surgery at Northern Westchester Hospital in Mount Kisco, N.Y.

The minimally invasive surgery is slightly more expensive than a standard rotator cuff repair, but most insurance companies and Medicare cover the cost of the procedure, Karas noted.

Mihata said the surgery isn't difficult for an experienced surgeon to learn. But Karas pointed out that it is "technically challenging to perform." He recommended choosing a fellowship-trained shoulder surgeon who has a lot of experience performing minimally invasive surgeries.

The recovery time is approximately three to six months in males, and six to 18 months in females, according to Mihata, but pain relief comes much sooner.

Karas said the complication rates are also low for this procedure.

The findings were presented recently at the American Orthopaedic Society for Sports Medicine annual meeting in Toronto. Findings presented at meetings should be viewed as preliminary until they've been published in a peer-reviewed journal.

SOURCES: Teruhisa Mihata, M.D., Ph.D., assistant professor, and chief, shoulder and elbow surgery and sports medicine, Osaka Medical College, Japan; Evan Karas, M.D., co-chief, orthopedic surgery, Northern Westchester Hospital, and co-director, Orthopedic and Spine Institute, Mount Kisco, N.Y.; July 22, 2017, presentation, American Orthopaedic Society for Sports Medicine annual meeting, Toronto

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