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S sc repair final

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S sc repair final

  1. 1. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 How to do a subscapularis repair 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 subscapularis repair Verona 13.06.2017 Lateral decubitus My preferred position Positioning the patient
  3. 3. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair • Dorsal portal • Anteroinferior portal • Anterosuperior portal  30° or 70° arthroscope
  4. 4. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Classification of SSC-tears (Fox and Romeo) Type I Partial thickness tear Type II Complete tear of the upper 25% of the tendon Type III Complete tear of the upper 50% of the tendon Type IV Complete rupture of the tendon
  5. 5. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair Instability or tear of LBT : tenotomy or tenodesis Repair of SSC then
  6. 6. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair Burkhart Stephen Posterior level push
  7. 7. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Posterior lever push
  8. 8. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair  look for the ‘comma-sign‘
  9. 9. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Coracoid Impingement Roller-wringer effect  Normal coracohumeral space: 8-10mm Burkart St. Cowboy´s guide to advanced shoulder arthroscopy
  10. 10. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair - tear
  11. 11. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 The coma sign
  12. 12. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair – tear the coma sign (another example)
  13. 13. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Opening the rot interval –preparing the space
  14. 14. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Marking with a suture the superior edge of the subscapularis
  15. 15. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair Mobilization of SSC tendon • anterior (open the rotator interval, free from coracoid process ) • posterior (from glenoid neck) • Superior from coracoid
  16. 16. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair - mobilization
  17. 17. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis release anterior superior and posterior
  18. 18. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair Debridement of the footprint Lichtenberg, Habermeyer, Magosch
  19. 19. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair Anchor / sutures 1 anchor (partial tear) 2 anchors (complete tear) Lichtenberg, Habermeyer, Magosch
  20. 20. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 ANCHOR INSERTION
  21. 21. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair  Knot tying Lichtenberg, Habermeyer, Magosch
  22. 22. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair – suture management
  23. 23. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Subscapularis repair - final
  24. 24. www.shoulder.gr E. Antonogiannakis How to do a subscapularis repair Verona 13.06.2017 Thank you for your attention!!! Save the date: 1-3 February 2018

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