Austin OrthoBiologics: State of the Art 2021 Part I - Shoulder

 Dr. Kelly Cunningham and the team at Austin Ortho+Biologics have developed a focused and reproducible strategy for dealing with orthopedic problems of the shoulder.

Through years of research and literature review, clinical orthopedic practice and evaluation of results, methods of treatment have evolved to deal with various common injuries, often in mature athletes.

 These biologic techniques can be used as a stand-alone procedure or in combination with outpatient shoulder surgery:

    Shoulder Injury                                     Treatment Recommendation

Rotator cuff tear

     Partial                                    <50%        PRP  or  MSC*  

                                                    >50%        PRP + surgical repair (failed PT trial^)

    Complete                                  small (<2 cm)             PRP + surgical repair ^

                                                       mod/large (>2 cm)     MSC + surgical repair ^

      notes:   PRP (Platelet-Rich Plasma injection, patient-derived) has demonstrated an ability to relieve pain, improve function & provide growth factors to rotator cuff injury - in contrast to steroid injection, which may limit healing & treatment options

                  Cellular therapy (MSC “stem cell” injection, patient-derived/bone marrow) appears to improve surgical healing in larger full-thickness tears, and may allow healing of partial/smaller tears without surgery *

                  PT trial  =  an initial course of Physical Therapy, based on patient-specific activity, to attempt to delay/avoid surgery ^

Arthritis    

        Mild                                        PRP  +  PT, activity modification

       Moderate/severe                    MSC  + PT, activity modification

                                                     if positive MRI findings, surgery “clean-up”+ MSC

     notes:   PRP, MSC with successful pain relief is based on similar use/studies in the arthritic knee, enhanced by the non-weight-bearing status of the shoulder

                excellent results often obtained with or without combined surgery, which is indicated in younger or more active patients with “mechanical” symptoms of labral tear, loose bodies (as noted on MRI) and/or capsule contracture that limits motion

                severe arthritis may eventually need joint replacement, but biologics offers a chance to delay or even avoid such an aggressive surgery

Labral  (“cartilage rim”)  tears,  biceps disease

           Pain only                                               PRP        

           Pain + mechanical symptoms             surgical repair + PRP

       notes:   “mech symptoms” are catching, locking, dislocation of the tendon; affecting activities

                    PRP provides growth factors that aid in healing surgical repair

                    biceps reattachment may be indicated for recurrent labral tears or torn biceps, especially at a certain age

Dr. Cunningham is a board-certified, fellowship-trained orthopedic surgeon with special interest in the treatment of cartilage injuries and degeneration of the shoulder, knee, hip and elbow.

He focuses on non-surgical and surgical care of his patients, using innovative and cutting-edge regenerative sports medicine techniques. He has practiced in Austin, Texas, for over 30 years.

austinorthobio.com

Author

Dr. Kelly Cunningham Physician