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Evag rot cuf


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Evag rot cuf

  1. 1. Emmanuel Antonogiannakis Director, 2nd Orthopaedic Department, Athens Army Hospital Arthroscopic Rotator Cuff Repair
  2. 2. Rotator cuff disease is a spectrum of clinical conditions, which range from asymptomatic partial thickness tears to symptomatic rotator cuff arthropathy
  3. 3. Successful RC Repair Codman EA. Rupture of the supraspinatus tendon Boston Medical & Surgical Journal 1911 Vol clxiv (2) 708-10 McLaughlin HL. Lesions of the musculotendinous cuff of the shoulder: the exposure and repair of tears with retraction. J Bone Joint Surg 1944;26:31-51. First Description of RC tears Smith JG. London. Med Gaz, 1834,14:280 Pathological appearances of seven cases of injury of the shoulder joint, with remarks. EA Codman HL McLaughlin
  4. 4. The Gist of Operative Treatment  Stable RC repair  Restoration of tensile strength  Creation of an environment that facilitates healing mediated by the bursa  Prevention of bone/tendon gap formation Example of applied basic science in surgery
  6. 6. Stable fulcrum(SS-part IS) Unstable fulcrum(SS-IS)
  7. 7. Full vs Partial Thickness Rotator Cuff Tears
  8. 8. Partial RC tear Joint side vs bursal side tears
  9. 9. COMPLETE TEARS • Small 1cm • Medium 2-3cm • Large 3-5 cm • Massive >5cm
  10. 10. Surgical Technique 1. GH Joint and Subacromial Joint Inspection 2. Bursal debridement 3. Acromioplasty 4. Cuff mobilization 5. Repair (side to side, tendon to bone)
  11. 11. Patient position Lateral decubitus Traction3-4 kgr Abduction 20 degrees
  12. 12. Portals Outside in technique
  13. 13. Portal creation
  14. 14. Bleeding control
  15. 15. Bleeding control
  16. 16. Bleeding control
  17. 17. Cuff Inspection, Partial Tear
  18. 18. Cuff Inspection, Complete Tear
  19. 19. Crescent Shaped Tear
  20. 20. Closing an L-shaped or U-shaped tear is much like closing a tent flap Closure of an U-shaped tear involves first side-to-side closure of the vertical limb of the tear, then tendon-to-bone closure of the transverse limb L or U -shaped tear
  21. 21.  Large U-shaped cuff tear extending to glenoid  Margin convergence  The free margin of the cuff is repaired to bone with suture Cuff mobilization
  22. 22. Margin convergence Balancing of Force Couples (shift posterior leaf of cuff)
  23. 23.  Large U-shaped cuff tear extending to glenoid  Margin convergence  The free margin of the cuff is repaired to bone with suture anchors
  24. 24. Single and double interval slide • Anterior slide through release in the rotator interval (supraspinatus–coracobrachialis) • Posterior slide through release of the interval supraspinatus-infraspinatus
  25. 25. Side to Side Repair Cuff repair
  26. 26. Side to Side Repair
  27. 27. Cuff repair Tendon to bone repair
  28. 28. Double Row Fixation Restoration of the footprint
  29. 29. Double Row Fixation
  30. 30. Double Row Fixation
  31. 31. Double Row Fixation
  32. 32. Subscapularis Repair Recognition
  33. 33. Subscapularis Repair
  34. 34. Long head of bicepts tenodesis
  35. 35. Arthroscopic repairs do not heal faster Knowledge of biomechanical principles is mandatory in choosing repair type Cuff repair is feasible but technically demanding
  36. 36. Indications of arthroscopic cuff repair • Every repairable cuff tear can be repaired arthroscopic or a cuff that can be repaired open can be repaired and arthroscopic • The decision to repair a cuff tear open or arhtroscopic depends in the expertise of the surgeon • In the long run there is no discernible difference between mini-open and arthroscopic cuff repairs
  37. 37. Arthroscopic cuff repair Wolf, Snyder, Gartsman, Esch, Burkhart, Tauro and others reported 84%-94% excelent and good results
  38. 38. • Bennett WF. Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003 • Boileau P., Brassart N., Watkinson D.J., Carles M., Hatzidakis A.M., Krishnan S.G. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005 • Buess E., Steuber K.U., Waibl B. Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases. Arthroscopy. 2005 • Gartsman G.M., Khan M., Hammerman S.M. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg. 1998 • Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy. 2005 • Tauro JC. Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. Arthroscopy 1998 • Warner JJ, Tetreault P, Lehtinen J, Zurakowski D. Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study. Arthroscopy. 2005 Results of atrhroscopic rc repair
  39. 39. Advantages of Arthroscopic Cuff Repair • Atraumatic • Deltoid sparing • Tissue mobilization • Cosmetic incisions • Secure repair • Address accompanying pathology • No iatrogenic injury to healthy tissues • Cost-effective on an outpatient basis
  40. 40. Disadvantages of Arthroscopic Cuff Repair • Technically demanding • Equipment dependent • Steep learning curve Know when to keep dealing or when to pack the cards in and go home