Were You Told Your Rotator Cuff Is Irreparable? There Is Another Option.
If you have a massive rotator cuff tear that your surgeon says cannot be fixed, you may have been given three options: live with the pain, undergo a complex reconstructive procedure with a long recovery, or have a shoulder replacement. For many patients — especially those who are too young for a replacement, have significant medical conditions, or simply cannot tolerate months of rehabilitation — none of these options is acceptable.
Dr. Raffy Mirzayan invented a fourth option: Biologic Tuberoplasty™.
This is a 30-minute, all-arthroscopic outpatient procedure with a sling worn for only three weeks and return to activities as tolerated shortly after. It was invented, published, and pioneered by Dr. Mirzayan, and is now performed by surgeons around the world following his published technique.
To find out if you are a candidate, call (310) 746-5918 or request a consultation online. Virtual consultations are available for patients traveling from Las Vegas, Henderson, Phoenix, and Scottsdale.
Understanding the Problem: Why Massive Rotator Cuff Tears Are So Difficult to Treat
The rotator cuff is a group of four tendons that stabilize the shoulder and allow you to lift your arm. When two or more of these tendons tear completely and retract — a condition called a massive, irreparable rotator cuff tear — the humeral head (the ball of the shoulder) loses its soft tissue covering and its stabilizing force couple.
When you try to lift your arm, the deltoid muscle contracts and pulls the humeral head upward instead of outward. The greater tuberosity — the bony prominence on the top of the humerus — then grinds directly against the acromion (the bone above it), creating painful bone-on-bone contact. Over time, this wears away the acromion, a process called acetabularization, and causes progressive deterioration of the shoulder.
This is the primary source of pain in patients with massive irreparable rotator cuff tears — and it is the exact problem that Biologic Tuberoplasty™ is designed to solve.
The Invention: What Is Biologic Tuberoplasty™?
Dr. Mirzayan made a key observation during his research on Superior Capsule Reconstruction (SCR) — a complex procedure used to treat massive rotator cuff tears. When he analyzed postoperative MRI scans, he noticed that patients whose grafts had partially torn but still covered the greater tuberosity had outcomes just as good as patients with a perfectly intact graft. Those whose grafts had torn away from the tuberosity, leaving it bare, did poorly.
The conclusion was clear: what mattered was not the complexity of the reconstruction — it was whether the tuberosity was covered with biological tissue that prevented bone-on-bone contact with the acromion.
Dr. Mirzayan coined the term "Biologic Tuberoplasty Effect" to describe this phenomenon and published it in the Orthopaedic Journal of Sports Medicine in 2019. He then developed a standalone procedure — Biologic Tuberoplasty™ — that achieves this goal directly, without the complexity, cost, and lengthy rehabilitation of a full Superior Capsule Reconstruction.
The procedure involves arthroscopically securing an acellular dermal allograft (a biological tissue graft) directly over the greater tuberosity, covering it completely. This graft acts as a permanent interpositional cushion, preventing the bone-on-bone contact that causes pain — without requiring a full shoulder reconstruction.
Dr. Mirzayan is the inventor of Biologic Tuberoplasty™, a minimally invasive, arthroscopic procedure where donated human skin is attached to the top of the ball of the ball and socket joint in patients with massive, irreparable rotator cuff tears and who may have been told they need a reverse shoulder replacement. The procedure is a same day surgery, lasts about 1 hour and patients can be back to sports relatively quickly with minimal downtime.
The Published Evidence — A Decade of Science
Dr. Mirzayan has built the most comprehensive body of evidence on Biologic Tuberoplasty of any surgeon in the world, with publications spanning from the original discovery in 2019 to the definitive multicenter trial in 2026:
2019 — The "Biologic Tuberoplasty Effect" (Orthopaedic Journal of Sports Medicine) The discovery. Dr. Mirzayan first described and named the phenomenon — patients whose grafts covered the greater tuberosity had equivalent outcomes to those with an intact graft. He coined the term "Biologic Tuberoplasty Effect" and proposed covering the tuberosity directly as a standalone treatment strategy. This paper launched an entirely new treatment category.
2021 — Surgical Technique (Arthroscopy Techniques) The blueprint. Dr. Mirzayan published the step-by-step arthroscopic technique for Biologic Tuberoplasty, making it reproducible for surgeons worldwide. Multiple other surgeons have since published their own variations, all citing Dr. Mirzayan's original technique.
2022 — Graft Tear Classification System (Clinical Imaging) The framework. Dr. Mirzayan created and published the first classification system for graft tears following Superior Capsule Reconstruction — the scientific foundation that explains why tuberosity coverage is the critical factor in successful outcomes.
2023 — Preliminary Clinical Outcomes (Cureus) The proof of concept. The first outcomes study of Biologic Tuberoplasty as a standalone procedure. Ten patients achieved dramatic improvements: ASES scores from 24.3 to 91.5, SANE scores from 22.5 to 88, and pain scores from 8.8 to 1.1 out of 10. 100% of patients achieved clinically meaningful improvement. MRI confirmed complete graft healing in all cases.
2023 — AAOS Instructional Course Lecture (Instructional Course Lectures, Vol. 72) The mainstream recognition. Dr. Mirzayan presented Biologic Tuberoplasty as an emerging treatment option at the American Academy of Orthopaedic Surgeons — the most prestigious platform in orthopaedic surgery — alongside balloon arthroplasty and lower trapezius transfer as the future of massive rotator cuff tear management.
2024 — Landmark Outcomes Study (American Journal of Sports Medicine) The validation. In 39 patients with up to 8 years of follow-up, Dr. Mirzayan confirmed that patients with tuberosity-covered grafts had outcomes statistically equivalent to intact grafts — ASES 88.5 vs 86.1, SANE 85.4 vs 83.2. 100% achieved clinically meaningful improvement. Published in the most prestigious sports medicine journal in the world.
2026 — Graft Thickness Study (Arthroscopy) The refinement. Dr. Mirzayan's research demonstrates that thicker dermal allografts lead to lower rates of lateral-sided graft tears and better functional outcomes, further optimizing the technique for patients.
2026 — Definitive Multicenter Study (Arthroscopy) — The Gold Standard The definitive proof. Published in January 2026 in Arthroscopy — the world's leading arthroscopic surgery journal — this multicenter study involving 9 co-authors across multiple institutions confirmed that Biologic Tuberoplasty leads to significant improvement in functional outcomes in patients with massive, irreparable rotator cuff tears. This is no longer a single surgeon's experience — this is the scientific community at large validating Dr. Mirzayan's invention as an effective, reproducible treatment for one of the most challenging problems in shoulder surgery.
Mirzayan R, David TS, Griffin JW, Suri M, McCarty LP 3rd, Harrison RJ, Gilot GJ, Stark ES, Bonner KF. Arthroscopy. 2026 Jan;42(1):108-122.
Who Is a Candidate?
Biologic Tuberoplasty™ is designed for patients who have:
A massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus, failed nonoperative treatment (physical therapy, injections, anti-inflammatory medications), significant pain and limited shoulder function, Hamada grade 1 or 2 on X-ray (no or minimal superior migration of the humeral head), and an intact subscapularis tendon.
This procedure is particularly well-suited for older patients (typically 65 and above) who are not candidates for shoulder replacement, patients with medical comorbidities who cannot tolerate lengthy surgery or anesthesia, patients with poor bone quality who are at high risk for anchor pull-out with more complex procedures, patients who need a quick recovery and cannot commit to 3–6 months of rehabilitation, and patients who want to preserve all options for future surgery.
What to Expect
Surgery type: Outpatient arthroscopic — go home the same day. Surgery duration: Approximately 30 minutes. Anesthesia: General. Sling: 3 weeks for comfort. Return to activity: Active range of motion begins at week 4; strengthening at 6 weeks; full pain-free range of motion typically achieved by 3 months. Results: In Dr. Mirzayan's published series, 100% of patients achieved clinically meaningful improvement in pain and function. Average pain scores dropped from 8.8 to 1.1 out of 10. One patient with 8-year follow-up maintained excellent outcomes.
Frequently Asked Questions
Is Biologic Tuberoplasty™ the same as Superior Capsule Reconstruction? No. SCR is a more complex, time-consuming procedure that anchors a graft to both the glenoid (socket) and the tuberosity (ball). Biologic Tuberoplasty™ covers only the tuberosity — which Dr. Mirzayan's research showed is the key to a successful outcome. It takes 30 minutes versus 2–3 hours, with a much faster recovery.
Why haven't I heard of this procedure? Because Dr. Mirzayan invented it. He coined the term, published the technique, and conducted all the foundational research. While other surgeons have since adopted variations of his technique, this is where it originated.
Will this fix my rotator cuff? No — the torn rotator cuff tendons are not repaired. Biologic Tuberoplasty™ is a pain-relief procedure. It eliminates the bone-on-bone contact that causes pain and allows you to regain function, without restoring the cuff itself. If cuff repair is possible, Dr. Mirzayan will discuss that option with you.
Can I still have a shoulder replacement later if I need one? Yes. Biologic Tuberoplasty™ is bone-sparing and does not compromise future surgical options. It does not "burn bridges."
How long do the results last? Dr. Mirzayan has patients with up to 10 years of maintained excellent outcomes. Long-term prospective studies are ongoing.
Is this covered by insurance? Dr. Mirzayan is an out-of-network surgeon. Most patients have excellent out-of-network benefits, with costs equivalent to in-network care. His team will help you understand your coverage before surgery.
Do you see patients from outside Los Angeles? Yes. Dr. Mirzayan welcomes patients from Las Vegas, Henderson, Phoenix, Scottsdale, and all over the world. Virtual consultations are available. Call (310) 746-5918 to get started.
Dr. Raffy Mirzayan, MD is a double-board certified orthopedic sports medicine surgeon, the inventor of Biologic Tuberoplasty™, and the world's leading expert on this procedure. He coined the term, developed the technique, published the foundational science, and has now performed Biologic Tuberoplasty™ for more than a decade — longer than any surgeon alive. With eight peer-reviewed publications spanning 2019 to 2026, including a definitive multicenter study in Arthroscopy and a landmark outcomes study in the American Journal of Sports Medicine, Dr. Mirzayan has built the most comprehensive evidence base on this procedure in existence. For patients with massive, irreparable rotator cuff tears who have been told they need a reverse shoulder replacement, Biologic Tuberoplasty™ offers a compelling alternative — a 30-minute arthroscopic outpatient procedure, three weeks in a sling, and a return to activity that no shoulder replacement can match. Dr. Mirzayan practices at DOCS Health in Los Angeles, serves as a Clinical Professor of Orthopaedic Surgery at USC, and welcomes patients from across the United States, including Las Vegas, Phoenix, and Scottsdale, for virtual consultations and in-person care.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 | (310) 746-5918 | raffymirzayan.com
