1. Joe Tippet Staged Rotator Cuff Repair

2. METHOD 26 patients 2 - 6 year follow-up 26 patients 2 - 6 year follow-up

3. METHOD UCLA Scale Xray Cybex Physical exam UCLA Scale Xray Cybex Physical exam

4. ASSOCIATED FINDINGS 5 full thickness rotator cuff tears 5 partial thickness tears 4 glenohumeral DJD 5 full thickness rotator cuff tears 5 partial thickness tears 4 glenohumeral DJD

5. ASSOCIATED SURGERY 4 rotator cuff repairs 1 rotator cuff debridement 4 rotator cuff repairs 1 rotator cuff debridement

6. RESULTS UCLA Score –Mean 32/35 –Range 21 - 35 UCLA Score –Mean 32/35 –Range 21 - 35

7. RESULTS - UCLA Excellent20 Good 2 Fair 2 Poor 2 Excellent20 Good 2 Fair 2 Poor 2

8. RESULTS - PHYSICAL EXAM ROM Full 22 ROM decreased 4 AC joint tenderness 1 ROM Full 22 ROM decreased 4 AC joint tenderness 1

9. RESULTS - XRAY.6 - 1.6 cm resection Calcification 5/26.6 - 1.6 cm resection Calcification 5/26

10. Joe Tippet Staged Rotator Cuff Repair

11. Results – AANA 98 7.5 patients Stage I 75% good & excellent 7.5 patients Stage I 75% good & excellent

12. Results – AANA 98 30 Patients Stage II 95% good & excellent 30 Patients Stage II 95% good & excellent

13. Conclusions Residual defect is not painful Debridment vs Repair Ogilvie – Harris Residual defect is not painful Debridment vs Repair Ogilvie – Harris

14. Conclusions Goal is to restore biomechanics Allografts and tendon transfer not necessary Goal is to restore biomechanics Allografts and tendon transfer not necessary

15. Results – AANA 98 30 Patients Stage II 95% good & excellent 30 Patients Stage II 95% good & excellent

16. Results – AANA 98 7.5 patients Stage I 75% good & excellent 7.5 patients Stage I 75% good & excellent

17. Rotator Cuff Tears Partial and Staged John F. Meyers, M.D.

18. Rationale

19. Harryman Ultrasound 50% of tears > supraspinatus had recurrent defect Ultrasound 50% of tears > supraspinatus had recurrent defect

20. Calvert Arthrogram 18 of 20 shoulders leaked 17 no pain 15 full elevation Arthrogram 18 of 20 shoulders leaked 17 no pain 15 full elevation

21. Burkhart “Functional Rotator Cuff Repair”

22. Anatomically deficient Biomechanically intact Anatomically deficient Biomechanically intact

30. Average Tear 20.1cm 4x5 cm 20.1cm 4x5 cm

31. Average Residual defect 2.9 cm 1x3 cm 2.9 cm 1x3 cm

32. Results 2 excellent 6 good 5 fair 1 poor 2 excellent 6 good 5 fair 1 poor

33. Results Gained 90° forward flexion Gained 2.3 grades of strength Gained 90° forward flexion Gained 2.3 grades of strength

34. Conclusions Residual defect is not painful Debridement vs repair Ogilvie – Harris Residual defect is not painful Debridement vs repair Ogilvie – Harris

35. Conclusions Goal is to restore biomechanics Allografts and tendon transfer not necessary Goal is to restore biomechanics Allografts and tendon transfer not necessary

36. Rotator Cuff Tears Partial and Staged Repair John F. Meyers, M.D.