Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations

Presentation on theme: "ARTHROSCOPIC ROTATOR CUFF REPAIR T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center."— 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 Flawlessly perfect knots

17 RESULTS Gartsman, JBJS, 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% most recent f/u

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


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










31 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

32 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

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

Similar presentations

Ads by Google