Q&A: Scripps orthopedic surgeon Brian Rebolledo begins unique treatment for shoulder injuries
Scripps has become one of the first facilities in San Diego and throughout the U.S. to use a small balloon implant instead of surgery to treat some patients with rotator cuff injuries.
The FDA recently approved the balloon implant for certain patients, including those with massive and irreparable rotator cuff tears. Rancho Santa Fe resident Dr. Brian Rebolledo, an orthopedic surgeon at Scripps, discussed his background, how the implant works and other aspects of rotator cuff health.
This interview has been lightly edited for clarity and conciseness.
Q: How did you become an orthopedic surgeon and when did you start working for Scripps?
“I have been at Scripps for a little over four years. I trained in New York, I went to Stanford for a fellowship and I’m a sports medicine trained physician. Worked with the 49ers for a year as well. I wanted to become an orthopedic surgeon because it kind of blended all the world’s medicine that I really liked. I liked seeing fixes to finite problems that we can fix from a physical standpoint. Orthopedic surgery is very mechanical in terms of what we do, in terms of how we figure things. And on top of that, we really see the results pretty quickly in terms of making people better right away. I’ve enjoyed it because it blends surgery and medicine to make people feel better and improve their lifestyles.”
Q: What exactly is the balloon implant and how does it work?
“This is actually for a select group of patients. There are almost a half a million rotator cuff repairs done annually, and that is still something we do very commonly. However, we have run into a subset of patients who have a rotator cuff tear that is very large and likely irreparable. Repair would likely fail or probably be of limited benefit. Yet they’re sometimes young and very active and a replacement may be a little too soon, so they fall into this gray area. And for a long time, we didn’t have a great solution in terms of what we could do to help manage the symptoms for patients and keep their function very high.
“A new procedure has come about. It’s been in Europe for about a decade, but it was just recently approved in the United States. We’re inserting a subacromial spacer, so it’s a balloon that goes into the shoulder joint, above the ball part and below the bone above it, and that acts as a cushion between those two bones to help alleviate pain and hopefully still maintain a lot of the activity that the patient wants to return to.”
Q: How does the balloon implant compare and contrast with traditional surgery?
“Typically the procedure is much quicker because it’s much easier to insert the balloon and inflate it, and so typically recovery is also quicker because we’re not waiting for a tendon, necessarily, to heal back down to the bone. And so it can be sometimes a week to two weeks in a sling, but we typically start motion pretty quickly thereafter with the expectation that they really start to activate those muscles and become much more functional by about six weeks. It’s very different from traditional rotator cuff repair where we typically have a patient in a sling and largely immobilized for four to six weeks before we start any kind of motion for them.”
Q: How do patients typically end up with an irreparable tear?
“For someone to end up with an irreparable tear, it typically is something that has bothered someone for some time, but it’s really a finding that we determine based on their MRI. So the MRI can show they have a very big rotator cuff tear and they probably had it for some time, and we usually couple that with some of the other findings like the size of it and atrophy that’s present within the muscle. Those are really the subset of patients that we start to entertain the idea of using this as a good adjunct in terms of providing some of that relief.”
Q: Are there any preventative measures people can take, in terms of stretches of exercise, to reduce their risk of damaging the rotator cuff?
“Generally speaking, you want to maintain the stability and strength of that shoulder. So a lot of times, working on the scapular stabilizing muscles around the shoulder, including the deltoid muscle, are helpful in terms of offsetting and helping to prevent shoulder dysfunction related to a rotator cuff tear. And so those are things that we focus on no matter what. Whether it’s a large tear or small tear, these are things that are best suited to help maintain the best function of the shoulder. But if things do deteriorate, those are times you want to see a physician to have it properly evaluated instead of grinning and bearing it when something could be getting worse over time.”
For more information, visit scripps.org/balloonimplants.
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