Ledes from the Land of Enchantment

Q&A: Scripps orthopedic surgeon Brian Rebolledo begins unique treatment for shoulder injuries

Scripps is one of the first facilities in San Diego and across the United States to use a small balloon implant instead of surgery to treat some patients with rotator cuff injuries.

Dr. Brian Rebolledo

(Courtesy Scripps)

The FDA recently approved the balloon implant for certain patients, including those with massive and irreparable rotator cuff tears. Brian Rebolledo of Rancho Santa Fe, an orthopedic surgeon at Scripps, shared his background, how the implant works, and other aspects of rotator cuff health.

This interview has been edited slightly for the sake of clarity and conciseness.

Q: How did you become an orthopedic surgeon and when did you start working at Scripps?

“I’ve been with Scripps for a little over four years. I trained in New York, went to Stanford on a scholarship, and became a doctor in sports medicine. Also worked with the 49ers for a year. I wanted to be an orthopedic surgeon because it kind of brings together all of the medicine in the world that I really liked. I liked seeing fixes to finite problems that we can fix from a physical point of view. Orthopedic surgery is very mechanical in terms of what we do, in terms of the way we understand things. And on top of that, we really see the results pretty quickly to make people better right away. I enjoyed it because it combines surgery and medicine to make people feel better and improve their lifestyle. “

Q: What exactly is the balloon implant and how does it work?

“This is actually for a select group of patients. Nearly half a million rotator cuff repairs are performed annually, and we still do that very often. However, we have come across a subset of patients who have a very large and likely irreparable rotator cuff tear. A repair would likely fail or be of limited use. Still, they are sometimes young and very active and a replacement can come a little early so they fall into that gray area. And for a long time we didn’t have a great solution what to do to alleviate the symptoms of the patients and keep their function very high.

“A new process has emerged. It has been circulating in Europe for about a decade but was only recently approved in the United States. We use a subacromial spacer, i.e. a balloon that goes into the shoulder joint, over the ball part and under the bones above, and which acts as a cushion between these two bones to relieve pain and hopefully maintain a lot of activity that the patient wants to return. “

Q: How does the balloon implant compare and contrast with traditional surgery?

“Usually the procedure is much quicker because it is much easier to insert and inflate the balloon, and recovery is usually quicker too since we don’t necessarily have to wait for a tendon to heal back to the bone. It can sometimes take a week or two in a sling, but we usually start moving pretty quickly after that in the expectation that it will actually activate these muscles and become much more functional after about six weeks. It is very different from traditional rotator cuff repair, where we usually have a patient in a sling and largely immobilized for four to six weeks before starting any kind of movement for them. “

Q: How do patients typically end up with an irreparable tear?

“When someone ends up with an irreparable tear, it’s usually something that has bothered someone for a while, but it’s really something that we get based on their MRI. So the MRI can show they have a very large rotator cuff tear, and they’ve probably had it for a while, and we usually associate this with some of the other findings like the size and atrophy that is present in the muscle. This is really the subset of patients that we are starting to use this as a good supplement to get some of that relief. “

Q: Are there any preventive measures related to exercise to reduce the risk of rotator cuff damage?

“In general, you want to maintain that shoulder’s stability and strength. Therefore, working on the stabilizing scapula muscles around the shoulder, including the deltoid, is often helpful to offset and prevent shoulder dysfunction associated with a rotator cuff tear. And these are things that we definitely focus on. Whether it is a large crack or a small crack, these are things that are best for keeping the shoulder working at its best. But when things get worse, you want to see a doctor to have it checked properly instead of grinning and putting up with it when something might get worse over time. “

More information can be found at scripps.org/balloonimplants.

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