1 / 32

ARTHROSCOPIC ROTATOR CUFF REPAIR

ARTHROSCOPIC ROTATOR CUFF REPAIR. T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center. OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS. Treatment Options Treatment Principles Surgical Indications Advantages of ARCR Disadvantages of ARCR Technique for ARCR Results.

elina
Download Presentation

ARTHROSCOPIC ROTATOR CUFF REPAIR

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ARTHROSCOPIC ROTATOR CUFF REPAIR T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center

  2. OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS • Treatment Options • Treatment Principles • Surgical Indications • Advantages of ARCR • Disadvantages of ARCR • Technique for ARCR • Results

  3. TREATMENT OPTIONS • ASAD/debridement without repair • Open repair • Mini-open repair • Arthroscopic repair

  4. TREATMENT PRINCIPLES • Address associated pathology • Adequate decompression • Assess tear-size, retraction, pattern, tissue quality, repairability • Tendon mobilization • Secure repair • Supervised rehabilitation program

  5. SURGICAL INDICATIONS • Pain • Functional deficits • Failure to respond to nonoperative care • Full-thickness tear • Extensive partial-thickness tear • Acute injury

  6. ADVANTAGES OF ARCR • See both sides of cuff • Visualize all pathology-labral tears, biceps, OA, etc. • Easier releases(esp. capsule) • Less pain, morbidity • Smaller scars • Better ROM • PATIENTS WANT IT!

  7. DISADVANTAGES OF ARCR • Learning curve • ? Smaller contact area with bone for healing • High retear rate by ultrasound reported • ? Pain from resorption of anchors • Coding/reimbursement problems

  8. TECHNIQUE FOR ARCR • Define tear • Mobilize tendons • Prepare tuberosity • Cuff reduction • Place anchors • Suture management • Pass sutures through tear edge • Knot tying

  9. DEFINE TEAR • View from anterior and from posterior • Measure with probe known size • Trim ragged edges but preserve tissue

  10. MOBILIZE TENDONS • Place retention sutures • Release capsule • Anterior interval release • Posterior interval release

  11. PREPARE TUBEROSITY • Remove excrescences but preserve cortex • Trim tendon stump • Define footprint

  12. MARGIN CONVERGENCE • Begin cuff reduction • Work medial to lateral • Side to side sutures • Tie knots

  13. PLACE ANCHORS • At lateral aspect of footprint • Metal or biodegradable • Make sure well fixed in bone

  14. SUTURE MANAGEMENT • Keep track of portals • Avoid tangles • Think one step ahead • Move at steady pace

  15. PASS SUTURES THROUGH TEAR EDGE • Many devices available • Avoid tearing tendon • Line up puncture with anchor

  16. KNOT TYING • Perfect knots • Perfect knots • Flawlessly perfect knots

  17. RESULTS Gartsman, JBJS, 1998 • 73 arthroscopic RCR • Average age 60.7 yrs • All pts followed at least 2 yrs(30 mons) • 78% G/E relief of pain • 90% G/E satisfaction • None of the shoulders were rated G/E preop, 84% G/E @ most recent f/u

  18. RESULTS Burkhart, Arthroscopy, 2001 • 59 arthroscopic RCR • Average follow-up 3.5 yrs • 95% G/E result regardless of tear size • Rapid return overhead function(4 mons)

  19. CASE PRESENTATION

  20. CASE D.E. • 53 male RHD farmer • Left anterior shoulder pain x 2 years • No prior injury or surgery • Nonoperative Rx including PT, NSAIDS, injections, activity modifications, etc.

  21. PHYSICAL EXAM • Crepitus with PROM • Tenderness greater tuberosity • AROM 155/170, 55/75, L5/T10 • 3/5 power abduction & external rotation • Positive impingement tests

  22. SHOULDER ANATOMY

  23. SURGERY

  24. SUMMARY • Much recent enthusiasm regarding complete arthroscopic rotator cuff repair • For many, this newer technique may be preferable alternative to more traditional mini-open rotator cuff repair • Important that basic principles of rotator cuff repair not be compromised

  25. SUMMARY • Several short-term studies demonstrate excellent results comparable with those of traditional techniques • Choice of procedure based on variety of considerations, including patient expectations, pathoanatomy of the cuff, and arthroscopic skills of the surgeon

More Related