Most surgeons, asked about rotator cuff repair on the radio, would talk about how well it goes. Dr. Vani Sabesan, MD, an orthopaedic shoulder surgeon with the Orthopedic Center of Palm Beach County, led with the hard part instead. “We’re really good at fixing them,” she told Dave and Mike on Episode 9 of Pain 2 Power. “We’re not great at getting them to heal.”
That one sentence explains a lot about shoulder surgery, and about why the months after it matter so much. The rest of the half hour covered how she decides when to change a technique, why she thinks a lot of new technology is marketing, a crushed elbow that came home from Nashville, and why, in her words, nobody is at the end of the line.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
Seventeen million rotator cuffs, and one in three over 60
Dave brought up patch augmentations and biologics, a part of shoulder surgery he said not every surgeon is into. Dr. Sabesan started with the size of the problem. By her figure, about 17 million people suffer from a rotator cuff problem. Then she made it local. Sit in any retirement community, she said, and among the people over 60 around you, “one out of three people are going to have a rotator cuff pathology.”
So tears are common, and repairing them is something surgeons do well. Getting the repaired tendon to knit back to the bone is the part she called the weak spot. If you’ve had a cuff repair, or someone has told you that you might need one, that is the window your surgeon and your therapist are both working around.
Why age changes the healing math
Her explanation was plain biology. “I tell people in Palm Beach, 90 is the new 70,” she said. People here stay active far longer than they used to. The tissue doesn’t get the memo. “Our blood cells, our biology isn’t as good as when we were 20.”
That is the gap she is trying to close. Someone in their seventies who still plays several mornings a week wants a shoulder that keeps up, but the tendon being repaired is the age it is. Wanting it badly enough doesn’t change the tissue.
What a scaffold is meant to do
Her answer to that gap is a scaffold placed with the repair. She described the goal in her own terms: if you can create something that gives the tendon “a better chance to be 20 again, or 40, or maybe even just 60 again, you’re going to get better healing of that rotator cuff.”
Mike connected it to something the show comes back to often, that the body is a self healing mechanism if you let it be. The surgeon replaces or reinforces what needs it, and the body handles the rest. Whether a scaffold or patch is right for any particular shoulder is a decision for the surgeon doing the repair. What she made clear is why the idea exists at all.
Legacy, legends and evidence: how a surgeon decides to change
Dave opened the interview with a question he had been waiting to ask. The week before, Dr. Ryan Simovitch had talked about what to do and avoid after a reverse total shoulder. Dave pointed out that Dr. Sabesan has her reverse patients reaching behind them to put a hand in a back pocket within a couple of weeks. What does she do differently?
Her answer was a framework more than a technique. “Sometimes we build techniques based on legacy, sometimes we do legends, and sometimes we do evidence,” she said. She trained under some of the legends of shoulder replacement, and she credited one mentor in particular with helping develop the early systems. She also said she lives by his words about evidence.
That is how her practice ended up testing six weeks in a sling against moving within days, a study we covered in detail in Total vs. Reverse Shoulder Replacement: How Surgeons Decide. Her summary of the lesson was short: when the evidence shows something, “you have to change what you do.”
Knotless sutures, fourteen years ago
Dave asked about knotless rotator cuff repair, which he said makes a huge difference in the healing process. She said she started using knotless sutures about 14 years ago, at the suggestion of her residents and the device reps in her operating room. “And at the time, it was a heresy to do it,” she said. Mike’s reaction was that plenty of ideas in history were called heresy before they were accepted.
You don’t need to know what a knotless anchor looks like to get the point. Repair techniques keep changing, and some of the changes started as a suggestion from someone junior in the room.
Taking advice from the youngest people in the room
She was candid about where some of her best ideas come from. “I have young guys in the OR, reps, students, residents, and they’ll sort of say, hey, why don’t you try doing it this way? It might be better.” She takes it all with a grain of salt, she added, and looks for evidence behind it before anything changes. Then she said something about her own approach to patients: “I mean, you listen to your patients and you hear what their needs are and you try to advance what you do, how you do it with that.”
First of many to come
Mike made sure the audience knew who was sitting at the table. In the Florida Orthopaedic Society’s history (Mike put it at 75 years; she said 73 or 74 while she was still checking the number), the society had never chosen a woman as president until her. Mike called it a huge feather in her cap.
She passed the credit to her students. “Well, you know, I think it’s not about my cap,” she said. Her research fellows and medical students printed hats that read “first of many to come,” and that, she said, is the legacy she wants to leave.
Teaching runs through everything she said. She told the hosts she has trained probably over 100 medical students, and her mentees started a site called YourMedMom with advice for women and anyone who wants to train in orthopaedics. The name came from the way she teaches. She tells it like it is, sometimes things people don’t want to hear, the way a mom would, and always in their interest. The reps, she said, call her a spitfire. She also called the operating room her happy place, and said two students had told her that same day it was the most fun they’d had.
Dave had a personal reason to agree. His son Nick, sitting just off camera in the studio, worked as an orthopaedic trauma rep and did a lot of work with Dr. Sabesan. Dave said what stood out was that she was friendly with the reps, which he said is not always the case.
The hour in numbers
Dr. Sabesan used a lot of specific figures, and every one of them is hers, from her own patients and practice. Here they are in one place, with what she attached to each.
| Figure | What she said it refers to |
|---|---|
| About 17 million | People who suffer from a rotator cuff problem, by her estimate |
| One in three | People over 60 who will have a rotator cuff pathology |
| 98 percent | Her shoulder replacement patients who said in a survey that their therapist had a huge impact on their outcome |
| 95 percent | The same patients who said their therapist changed what they did and how they did it |
| 14 years | Roughly how long she has used knotless sutures for rotator cuff repair |
| Six offices | Her practice’s locations around Palm Beach County, by her count on the show |
| 28 marathons | How many she has run herself; she said she won one |
| 90 years old | A patient who came in two days before the taping and still exercises six days a week |
The therapy survey is the one we like best, for obvious reasons. Her comparison was a hairdresser: someone who talks to you and listens. It’s also why every visit here is one-on-one.
Tech that solves a problem, and tech that only looks good
Dr. Sabesan said she loves new technology and is part of a design team building implants 3D printed to a patient’s own anatomy. She is also skeptical of most of it. Her comparison was the iPhone. The phone itself was an incredible device, she said, but “do I think the 16 or the 17 version of it maybe is solving a huge unmet problem? Maybe not.” Her field is very implant driven, she said, and it can end up making technology for its own sake.
Her test for anything new is whether it gives the patient less pain, a faster recovery, bone that grows better or a cuff that heals. Robots in shoulder and joint surgery didn’t pass it. She said there hasn’t been much science showing they are the next panacea, and called them a great marketing tool.
What the robot doesn’t know
Dave added the therapy side. He said he has seen worse outcomes from some robotic procedures, especially in the knee and the hip, than from a surgeon who knows the patient’s anatomy. The robot “knows exactly what to do, but it doesn’t always know what not to do.” Mike called that the modern dilemma in medicine. Dr. Sabesan compared it to AI chat tools, which can get you so far but aren’t always accurate. “The technology is as good as the user,” she said.
If you’re choosing a surgeon, that is a fair thing to keep in mind. The tool on the brochure matters less than the person holding it and the plan for afterward.
Florida plays all year, and the pickleball courts know it
Mike pointed out how unusual this part of Florida is, with a population that is active and aging at the same time. Dr. Sabesan agreed, and added the other end of it: lots of young families and young athletes. “But the problem is, in Florida, we have the indulgence of being able to play all year round.”
She was generous about Dave here. She said she sends him her difficult athletes, and that he has gotten some of them back to the MLB level and back to being recruited. Her larger point was about rehab itself: “We really have to realize that rehab science in these sports is just as critical, probably maybe more critical than even, or as much of our surgical treatments.” She listed Tommy John surgery, rotator cuff surgery, tennis players, pickleball players and baseball players.
Then she described the patients in her own neighborhood who play competitive pickleball six days a week. Some of them come to her with one request. “They’re like, just shoot me up. Just get anywhere that I can so I can keep going.”
What Dave listens for at the first visit
Dave had a story of his own from 1990, when he was just starting out. One of his first patients told him to do whatever it took, with one condition: “don’t stop me from golfing.” Dave said that was when he realized how much the game meant to people here, and the clinic’s golf and throwing programs grew from there.
The goal isn’t always a game, though. Sometimes it’s reaching the top shelf again. Whatever you tell your therapist goes into your plan of care, Dave said, because your own description of the problem shapes the whole assessment. He gave a shoulder example. A patient mentions that it really aches at night, and that detail starts pointing the therapist toward something like a bursitis or a tendonitis. So tell us when it hurts, what you were doing, and how you sleep. Dr. Sabesan’s word for all of it was personalized: technology, technique and rehab all fitted to the person, which she called the best success.
A crushed elbow from Nashville, and no one at the end of the line
Asked for her most interesting case, Dr. Sabesan told a story she said she thought the patient would be fine with her sharing. A man who runs one of the country clubs up here was on a guys’ trip in Nashville when a drunk driver hit him. His elbow was destroyed, with severe nerve damage. At Vanderbilt Medical Center he was offered emergency surgery there, or a referral to a friend of the doctor’s in Palm Beach, who turned out to be her. He had already looked her up and made an appointment.
The first surgery didn’t heal, and a year later he still had severe nerve damage. She took him back for a revision. Six months after that, she said, he had full function back and the nerve damage had turned around, which he never thought would happen. She gave a lot of the credit to him, calling him the most optimistic guy she had ever met.
Why revisions are her favorite work
That case sums up how she talked about revisions. She said she probably enjoys the complex cases most, and gets sent a lot of them. “No one is at the end of the line to me,” she said. “We always have a chance of salvaging, making something better.” It comes from her own life too. “I mean, I’ve run 28 marathons,” she said, and everyone should at least have a chance to do something active. When Dave asked, she added that she had won one, and that the award was handed to her by a former senior resident of hers who had taken a job in Delaware.
Her picture of the future was the same idea stretched across a lifetime: young athletes with careers that last, and older athletes who get to keep doing what they love. Her example was the 90-year-old who had come in two days before the taping and still exercises six days a week. If you’re past 60 and wondering whether strength work is still worth starting, our piece on strength training after 60 is a good next read.
What this means if your shoulder is the one talking
None of this tells you what your shoulder needs. That takes an evaluation. But the episode does explain a few things we see every week at our clinic on US-1 in North Palm Beach.
After a repair or a replacement, your surgeon sets the protocol and we follow it. That protocol is built around how the tissue heals, and Dr. Sabesan’s point about older biology is exactly why the early weeks are paced the way they are. If you haven’t had surgery, our shoulder pain treatment page covers how we evaluate a sore cuff, and our post-surgical rehab page covers recovery after repairs and replacements. Elbow problems fall under our hand, wrist and elbow care, and the wider program is described on our physical therapy page. The first visit runs about an hour, one-on-one, and treatment usually starts that day. The getting started questions in our FAQ cover the rest.
You can read more about Dr. Sabesan’s background on her guest page, hear the whole conversation on the Pain 2 Power podcast page, and watch it in our video library. The show airs live Saturdays at 8:30 AM on 100.3 Legends Radio.
If a rotator cuff, a stiff elbow or a recovery that has stalled is what brought you here, call us at 561-624-4263 or request an evaluation. We see people from all over the north county, including Palm Beach Gardens and Jupiter.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.