Could Tuberoplasty help you postpone a reverse shoulder replacement?
Expert insight from Daniel Sohn, MD
Board-Certified Orthopaedic Surgeon
Southwest Michigan Center for Orthopaedics & Sports Medicine • St. Joseph, Michigan
Based on a discussion with Dr. Sohn on June 24, 2026
Publication date: 9/21/26
Medical review: 9/18/26
Being told that a rotator-cuff tear cannot be fully repaired can leave you wondering what comes next. Will you have to live with shoulder pain? Is a shoulder replacement your only option?
For some patients, biologic tuberoplasty may offer another path. This arthroscopic procedure places a tissue graft over an exposed area of the upper arm bone to cushion contact beneath the roof of the shoulder. The goal is to reduce pain and improve day-to-day function while preserving the natural joint. Read the published description of dermal tuberoplasty.
During a June 24, 2026 discussion, Daniel Sohn, MD, of Southwest Michigan Center for Orthopaedics & Sports Medicine, described tuberoplasty and related cable reconstruction as options he considers for selected patients with large, irreparable rotator-cuff tears. These procedures may help postpone a reverse shoulder replacement, although they cannot guarantee that replacement will never be needed.
What is an irreparable rotator-cuff tear?
The rotator cuff is a group of muscles and tendons that helps lift and rotate your arm and keeps the ball of the shoulder centered in its socket. Tears can develop after an injury or gradually as tendon tissue wears down. Symptoms may include pain at night, weakness, and difficulty reaching or lifting. AAOS explains rotator-cuff tears.
For an overview of local treatment options, explore SWM Ortho’s shoulder and upper extremity care.
A large tear is not automatically irreparable. An irreparable tear is one that cannot be adequately restored with a conventional tendon repair, often because of tissue deterioration, tendon retraction, or changes in the muscle. Your surgeon evaluates the tear, remaining muscle function, and joint condition to determine which treatments are realistic. Learn about the challenges of massive cuff tears.
How biologic tuberoplasty works
When the upper rotator cuff is severely damaged, the exposed upper arm bone can contact the undersurface of the acromion – the bony roof of the shoulder. Biologic tuberoplasty places a dermal allograft, a processed graft made from donated skin tissue, over the greater tuberosity, where rotator-cuff tendons normally attach.
The surgeon secures this graft arthroscopically, using a camera and instruments through small incisions. It provides a cushioning surface between the exposed bone and the acromion. Remaining tendons may also be repaired when possible.
Dr. Sohn explained the concept as placing a skin graft over the bone to reduce painful rubbing at the top of the shoulder. The purpose is to make the shoulder more comfortable and useful even when a complete cuff repair is not possible.
You may also encounter the term traditional tuberoplasty. That procedure reshapes the bone to allow smoother movement. This article focuses on the graft-based procedure Dr. Sohn discussed, also called biologic or dermal tuberoplasty. Read about traditional tuberoplasty.
Here is a video animation of how the procedure is performed.
Who may be a candidate?
Dr. Sohn particularly described patients in their 40s, 50s, and early 60s who remain active but have a large tear that cannot be fully repaired. For someone with a physically demanding lifestyle, preserving the natural shoulder may be an important goal.
However, age alone does not determine whether tuberoplasty is appropriate. The amount of arthritis and the shoulder’s remaining ability to move and function matter. A recent clinical study included patients who could actively raise their arm above shoulder height and had selected patterns of remaining tendon function and joint changes. Those results should not be assumed to apply to every irreparable tear. Read the clinical study.
An evaluation may include discussing:
- How pain and weakness affect sleep, work, and everyday activities.
- Whether nonsurgical treatment has provided enough relief.
- Which tendons can still be repaired or contribute to shoulder function.
- Whether arthritis or loss of movement makes another operation more suitable.
- Your expectations for lifting, exercise, and recovery.
Dr. Sohn noted that tendon healing can become less reliable with age. That does not mean patients cross a fixed age threshold at which repair stops working. Treatment decisions require an individual assessment.
How cable reconstruction fits in
Dr. Sohn also discussed cable plasty, or rotator-cuff cable reconstruction. He used the phrase “drawstring effect” to explain its intended role: helping the remaining cuff contain and support the ball of the shoulder when a complete repair is not possible.
The procedures have related but different aims. Tuberoplasty creates a cushioning surface. Cable reconstruction aims to improve mechanical support from the remaining cuff. Published surgical techniques describe combining them, but a description of how an operation is performed is not proof of its long-term effectiveness. Read the technique paper on tuberoplasty with cable reconstruction.
Dr. Sohn also described using a graft to reinforce thin tendon tissue during a repair. This is graft augmentation, which serves a different purpose from placing a cushioning graft over exposed bone. Ask which procedure – or combination – is being recommended for your shoulder.
Benefits and realistic expectations
Dr. Sohn described tuberoplasty as a smaller arthroscopic operation that may reduce pain, improve function, and provide time before a shoulder replacement becomes necessary. He also emphasized its limitations: it is an interim solution, not a complete restoration of a healthy rotator cuff.
Early clinical evidence is encouraging. A 2026 retrospective study of 50 patients reported improvements in pain and shoulder-function scores after biologic tuberoplasty, with average follow-up of approximately 23 months. However, it was a case series without a comparison group. It does not establish that tuberoplasty is better than other treatments or predict how long an individual patient’s benefit will last. Read the study and its evidence classification.
Possible problems include persistent pain or weakness, stiffness, infection, graft or fixation failure, and a need for further surgery. Your surgeon should explain the risks of the exact procedure planned and how any additional tendon repair changes those risks. Published technique literature also identifies graft healing and longer-term durability as concerns. Review the biologic tuberoplasty technique and limitations.
What recovery may involve
In the June discussion, Dr. Sohn initially estimated recovery at two to three months and clarified that it may take up to six months. He described rehabilitation as potentially less painful and somewhat shorter than recovery from a standard rotator-cuff repair in his experience.
Those estimates should be understood as a general discussion, not a deadline for recovery. A cushioning procedure alone may require a different rehabilitation plan from tuberoplasty combined with tendon repair or cable reconstruction.
Recovery commonly progresses from protecting the shoulder and managing discomfort to guided motion and later strengthening. Sling use, physical therapy, and return to work depend on the operation performed and your progress. Published rehabilitation protocols differ, reinforcing the importance of following your own surgeon’s instructions. See an example of a biologic tuberoplasty rehabilitation framework.
Feeling less pain does not necessarily mean the shoulder is ready for heavy lifting. Discuss your specific job duties, sports, and household responsibilities before surgery so the recovery plan reflects what you need to do.
When reverse shoulder replacement may be considered
Reverse shoulder replacement remains an important option for some patients with irreparable cuff tears, particularly when there is substantial arthritis or severe loss of shoulder function. It changes the joint’s ball-and-socket arrangement so the deltoid muscle can help lift the arm despite cuff deficiency. AAOS explains reverse shoulder replacement.
Dr. Sohn discussed patients who hope to postpone replacement because of concerns about activity restrictions and range of motion. Those concerns deserve an individual conversation: tuberoplasty does not guarantee unrestricted lifting, and restrictions after replacement vary with the patient and surgeon’s guidance.
The right choice depends on which treatment offers the most useful balance of pain relief, function, recovery, and durability for your shoulder.
Frequently asked questions
Does tuberoplasty repair the torn rotator cuff?
Biologic tuberoplasty primarily cushions exposed bone. It does not recreate the entire torn tendon. Your surgeon may repair portions of the cuff or add another procedure when appropriate. See the technique description.
Will I need a shoulder replacement later?
Possibly. Dr. Sohn described these procedures as a way to delay or potentially avoid replacement in selected patients. There is no guarantee that relief will be permanent or that arthritis and symptoms will not progress.
How long does tuberoplasty last?
There is no dependable lifespan that can be promised. Biologic tuberoplasty has encouraging early results, but current clinical evidence does not establish predictable long-term durability for every patient. Read the available outcomes study.
Am I too young or too old for the procedure?
Age is only one part of the decision. Although Dr. Sohn highlighted active patients in their 40s through early 60s, candidacy also depends on tissue quality, joint condition, remaining function, and goals. His examples are not an eligibility cutoff.
Will I need physical therapy?
Expect a rehabilitation plan tailored to your operation. Dr. Sohn described therapy as sometimes shorter than after conventional cuff repair, but additional repairs can change both the precautions and timeline.
When can I return to work or lifting?
There is no single schedule for every patient. Dr. Sohn discussed an overall recovery range of roughly two to six months, but clearance for demanding work or heavy lifting requires an assessment of healing, strength, and the procedures performed.
Does the graft come from my own skin?
The published dermal-allograft technique uses processed donor tissue. Confirm the specific graft with your surgeon, since graft materials and surgical plans can differ. Read about dermal allografts in tuberoplasty.
Is tuberoplasty covered by insurance?
During the discussion, Dr. Sohn said these procedures are handled similarly to rotator-cuff repair, including graft use. That is not a guarantee of coverage. Ask the practice and your insurer to verify the proposed procedure, graft coverage, authorization requirements, and expected out-of-pocket costs before scheduling. SWM Ortho’s forms and insurance information provides additional patient resources.
Are there nonsurgical alternatives?
Yes. Depending on your symptoms and health, treatment may include activity changes, physical therapy, medications, or selected injections. These approaches may improve symptoms without repairing the tear. Your surgeon can explain when continued nonsurgical care is reasonable. Explore SWM Ortho’s nonsurgical treatment options. AAOS describes treatment options.
Discuss your shoulder treatment options in St. Joseph
If shoulder pain or weakness is limiting your life – or you have been told your rotator-cuff tear cannot be fully repaired – an orthopaedic evaluation can help clarify your options.
To schedule an appointment with Dr. Daniel Sohn, or any of our other Orthopaedic Surgeons at Southwest Michigan Center for Orthopaedics & Sports Medicine, call 269-428-3500 or request an appointment online. The St. Joseph office is located at 183 Peace Boulevard, St. Joseph, MI 49085. Read Dr. Sohn’s biography on our surgeons page.
This article provides general education. Treatment and recovery depend on an individual evaluation; results vary.