Treatment of Rotator Cuff Tears: New Modalities and Innovations

Abstract

Although frequently performed, rotator cuff repair carries a not insignificant failure rate. A number of studies including biomechanical and clinical studies have attempted to identify factors affecting rotator cuff repair and healing. Poor prognostic factors likely include age, fatty atrophy of rotator cuff muscles, large tear size, chronicity, and smoking. Recent rotator cuff tear research has been devoted to addressing both biologic and structural concerns of repair. Adjuvant repair techniques aimed at improving biology have emerged, and many are now clinically available and include biologic patch augmentation, bone marrow aspirate, platelet-rich plasma, and utilizing local bone marrow egress. Novel structural techniques have been developed to augment, alter, or replicate the structural properties of rotator cuff, particularly in the setting of irreparable rotator cuff tears. These include subacromial balloon spacers, tendon transfers, superior capsular reconstruction, anterior cable reconstruction, bursal acromial reconstruction, and biologic tuberoplasty. This chapter will examine these novel biological and structural techniques and review available clinical outcomes.