"Unfixable" Rotator Cuff Tears Explained
What really happens in the OR during rotator cuff surgery… and what do surgeons do when the cuff can’t be fixed?
In this episode of The Shoulder Blueprint, orthopedic shoulder & elbow surgeons Dr. Caleb Davis and Dr. Justin Givens go deep on rotator cuff tears, repair strategies, and modern options for “irreparable” cuffs, all while keeping it understandable for both patients and clinicians.
ASES National Shoulder & Elbow Week is coming to Louisville, Kentucky in 2026, live at historic Churchill Downs, with guest faculty Dr. Mark Frankle and Dr. Mark Mille. World-class shoulder education, live horse racing, and a little Kentucky bourbon all in one place.
In this episode, you’ll learn:
-Why rotator cuff recovery takes so long (and why feeling good at 6 weeks doesn’t mean you’re healed)
-Arthroscopic vs open rotator cuff repair
-When “open” is actually safer and smarter
-Why subscapularis tears can change the whole game
-Partial tears vs full-thickness tears
-Bursal-sided, articular-sided, and interstitial “plywood” tears
-When nonoperative care is enough vs when surgery starts to make sense
-Single-row vs double-row repairs
-Biomechanics, tension, and why overtensioning can ruin a good repair
-To tie or not to tie the medial row (and how techniques are evolving)
-Patch augmentation for rotator cuff repairs
-Structural vs biologic patches
-What early results and real-world experience are showing
-What surgeons do when the cuff is “irreparable”
-Balloon spacers / balloon arthroplasty
-Superior capsular reconstruction concepts
-Tuberoplasty and why some surgeons are skeptical
-Reverse shoulder arthroplasty and when it’s truly indicated
-How patient selection, expectations, and rehab often matter as much as the operation itself
Whether you’re:
A patient facing rotator cuff surgery,
A resident or fellow trying to understand real-world decision making, or
A shoulder nerd who loves deep dives into biomechanics and technique…
…this episode gives you a front-row seat in the surgeons’ lounge.
