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How to do a sd & a dc resection

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How to do a sd & a dc resection

  1. 1. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 How to do a subacromial decompression and distal clavicle resection Manos Antonogiannakis Orthopaedic Surgeon Director of 3rd Orthopaedic Department Centre for Arthroscopy & Shoulder Surgery Hygeia General Hospital ESSKA Advanced Shoulder Arthroscopy Course All About Rotator Cuff & Other Subacromial Disorders Verona, 13-14 June 2017 .
  2. 2. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 History of acromioplasty Neer JBJS 1972. Anterior acromioplasty for impingement syndrome Bigliani 1986 the morphology of acromion ELMAN Arthroscopy 1987 .Arthroscopic subacromial decompresion Gaspari 1992 Presicion cutting block technique Nirschl 1989 Is acromioplasty nessecery ? Matsen JBJS 2005 no need for acromioplasty in rot cuff repair Tibone CORR 1985 no indication for subacromial decompression in young athletes
  3. 3. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 New conceps Critical Shoulder Angle (Gerber) >35 degrees increased danger of RC tears <35 degrees increased danger of OA
  4. 4. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017  Type 1: Flat  Type 2: Curved  Type 3: Hooked Acromial types (Bigliani) Type 3 Type 2 Type 1
  5. 5. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Positioning the patient Lateral decubitus My preferred position
  6. 6. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression • Posterior portal • Lateral portal P L AS AI N
  7. 7. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Portals for subacromial arthroscopy  Create the Lateral portal  3-4cm distal to the lateral acromion
  8. 8. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression Bursoscopy /Bursectomy OP Goal: Type 3 Type 1 Lichtenberg, Habermeyer, Magosch
  9. 9. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression  do not cut the Lig. coracoacromiale  localize the anterior and lateral edge of acromion  resect from lateral, the acromion hooked spur (anterior more than posterior)  resect the lateral edge of acromion Lichtenberg, Habermeyer, Magosch
  10. 10. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression  change portals, look from lateral  cutting-block technique Lichtenberg, Habermeyer, Magosch
  11. 11. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression – remove Bursa
  12. 12. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression – find the landmarks
  13. 13. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Subacromial decompression – Acromioplasty Landmarks: Anterior edge of the acromion Lateral edge of the acromion Anterolateral corner Ac joint
  14. 14. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection  Zanka View  T2-coronar MRI picture
  15. 15. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 AC pathology that can be treated by arthroscopy  AC arthritis  AC ganglion  AC dislocation
  16. 16. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection • Posterior portal • Lateral portal • Anterior portal (anterior from from ACJ) • Anterosuperior portal
  17. 17. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection  look from posterior, resect from lateral  resect 6-8 mm (2/3 from clavicle, 1/3 from acromion) resect parallel to the ACJ Kohn, Pohlemann
  18. 18. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection  do not resect the posterosuperior capsule (stability function)  denervate the rest bone  look from anterior Lichtenberg, Habermeyer, Magosch
  19. 19. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017  use 70˚ scope to complete excision
  20. 20. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017  check distance in abduction and external rotation
  21. 21. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection resect denervatecheck
  22. 22. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection – start from lateral
  23. 23. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection – anterior portal
  24. 24. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection
  25. 25. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection
  26. 26. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Distal clavicle resection – final check 8-10 mm space
  27. 27. www.shoulder.gr E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection Verona 13.06.2017 Thank you for your attention!!! Save the date: 1-3 February 2018

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