This document discusses techniques for repairing rotator cuff tears arthroscopically. It begins by describing the classification of partial versus full thickness tears and massive tears involving two or more tendons. For massive contracted immobile tears, interval slides can be performed through the anterior and posterior intervals to regain mobility. Repair techniques depend on the tear pattern, such as side-to-side sutures for U-shaped tears or interval slides for massive immobile tears. Results of arthroscopic repair for massive tears show 84-94% excellent or good results according to several studies. The key is to match the repair technique to the tear morphology and mobility to minimize strain on the repair.
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
The presentation includes new insight to rotator cuff anatomy, rotator cable, concept of force couple, different classifications of rotator cuff tear, signs and symptoms, special tests, non operative and operative management of rotator cuff tear, comparison of recent surgical modalities, management of irreparable cuff tears, post operative rehabilitation protocols, SLAP lesion, Parsonage Turner Syndrome
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
1. Shoulder Anatomy and Function Overview
2. Exercises for Healthy Shoulders
3. Good vs. Bad Pain
4. Overview of Common Sources of Shoulder Pain and Debility
5. Cutting Edge Treatments
6. Frozen Shoulder
- Causes and Treatment options
7. Unstable Shoulder
- Advances in Treatment
8. Rotator Cuff Tears -
Best Surgical Options Today
- Surgery Not Always Best Option
9. Shoulder Arthritis
- Many types of new surgeries
more at https://www.TheShoulderCenter.com/
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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1. Fixation techniques
in rotator cuff repair
Manos Antonogiannakis
Director
Center for shoulder arthroscopy
IASO General Hospital
Athens, Greece
2. Rotator Cuff Function
1. Dynamic stabilizer of the shoulder
2. Contributes strength to the arm
(50% of the abduction strength is generated by
supraspinatus)
3. Couple forces stabilize and regulate the
motion of the shoulder
www.shoulder.gr
3. Rotator Cuff disease
Rotator cuff disease is a wide spectrum
of clinical conditions, which range
from asymptomatic partial
thickness tears to symptomatic rotator cuff
arthropathy
www.shoulder.gr
4. Tears’ Definitions
• Partial Thickness Tears =
absence of communication between the
glenohumeral joint and the subacromial
bursa.
• Full Thickness Tears =
communication between the glenohumeral
joint and the subacromial bursa.
• Massive Tear =
Involving 2 or 3 tendons [Gerber]
or bigger than 5cm [Cofield]
www.shoulder.gr
5. Partial Thickness Tear
• Bursal side tears
• Articular side tears
• Intratendinus tears
Partial tear classification by Ellman
• Grade I <3mm deep
• Grade II 3-6mm deep
• Grade III >6mm deep (i.e. >50% thickness)
www.shoulder.gr
6. How frequent are RC Tears?
• Rotator Cuff Frequency:
30% of population
• Significant correlation with
age [Sher JS, Arthroscopy 1995]
www.shoulder.gr
7. Natural History of a Tear
• Tears DO NOT HEAL. Some but NOT ALL of them will
progress
• Rot cuff arthropathy is the end stage (4-20%)
• 50% of newly symptomatic tears will progress in size
• 20% of asymptomatic tears will progress.
• No Tear seem to decrease in size.
• 80% of partial tears progress in size or become full
thickness at 2 years
[Yamaguchi K., 2006, Nice Shoulder Course]
www.shoulder.gr
8. Partial Tears Treatment
• By far the most common partial tears are
Articular-side, vascular or age relateted
Traditionally partial tears classifications
are based to 50%
BUT
“How healthy is the remaining,
intact tissue?”
www.shoulder.gr
9. Partial Tears Treatment Options
1. Debride partial tear only
2. In-situ Repair
3. Convert to full thickness, Debride, Repair
Etiology makes the decision!!!
• Because most tears are degenerative, option 3
should be the best for most cases
• Trauma or young athletes are candidates for in-situ
repair
• If minimal partial tears cause significant pain then
debridement alone
[Yamaguch K, 2006 Nice Shoulder Course]
www.shoulder.gr
10. RC Tear Classification
Acute, Chronic, Acute on chronic
Tear Age Tissue Quality
1. Partial <40 Good
2. Complete <40 Good
3. Complete 40-65 Good
4. Complete 40-65 Bad
5. Complete >65 Good
6. Complete >65 Bad
www.shoulder.gr
15. Today’s Knowledge
• Rot cuff has some degree of reserve that affords
functional use of the arm in cases of limited tendon
deficiency.
• Location rather that size of a tear maybe more important
in the development of symptoms.
• Type of activities plays an important factor in the
development of symptoms
www.shoulder.gr
16. Goutallier fatty degeneration of muscles
• Stage 0 Normal muscle – no fatty streaming
• Stage 1 Occasional fatty streaming
• Stage 2 Fat<50% of cross sectioned area
Fat < Muscle
• Stage 3 Fat=50% of cross sectioned area
Fat = Muscle
• Stage 4 Fat>50% of cross sectioned area
Fat > Muscle
www.shoulder.gr
17. What to do???
• Patients with grade 3 or 4 fatty degeneration
DO NOT improve with rot cuff repair
[Goutallier]
Vs.
• Patients with grade 3 or 4 fatty degeneration
improved significant at 86% of cases after
arthroscopic repair
[Burkhart]
www.shoulder.gr
18. How to convert a Symptomatic tear to an
Asymptomatic re-tear
• Subacromial decompression and
debridmeut
• Biseps tenotomy
• Partial repair and healing of the rot cuff
• Adequate post-op rehabilitation
www.shoulder.gr
19. Early failure
of arthroscopic rot cuff repair
1. Failure of tendon-suture interface
2. Suture-anchor failure
3. Suture failure
www.shoulder.gr
20. RC Repair Results
• The rate of structural failure after open repair varies
from 20% to more 50%, while it is greater for
arthroscopic repairs
• First report of DOUBLE ROW repair:
Fealy S, Kingham TP, Altchek DW, Arthoscopy July 2002
Mini-open Rot cuff repair using a two row fixation technique
www.shoulder.gr
21. Conclusions
• Rot Cuf is extremely significant for the normal function of
the shoulder
• Rot Cuf tears can be asymptomatic
• Symptoms Produced by a tear depend on:
– Size
– Location
– Functional demands of the patient
www.shoulder.gr
22. Conclusions
• An anatomically deficient but biomechanical intact cuff is
possible
• Biomechanical intact cuff is the cuff that restores the
equilibrium of the force couples
• A cuff tear does not heal conservative
• A cuff tear after operative repair may yet not heal
• Partial healing may restore sufficient power to the cuff to
equilibrate the force couples
www.shoulder.gr
23. Conclusions
• Non-operative treatment strives to optimize the function
of the remaining cuff
• Rehabilitation after surgery strives to optimize the
function of the partially or completely healed cuff
www.shoulder.gr
24. ..so when we treat a RC tear…
We must try to:
• Optimize the anatomic integrity of the cuff by a repair
with minimal morbidity to the healthy tissues (mainly
deltoid)
THEN
• Rehabilitate vigorously the patient, to optimize the total
function of the shoulder
THEN
We can expect a majority of
satisfied patients
www.shoulder.gr
25. Our Results
• 41 pts single row repair
• Small 3 (7.31%)
• Medium 26 (63.41%)
• Large 5 (12.18%)
• Massive 7 (17.7%)
• Mean age 58.8 years
• Mean FU 14 months
• UCLA score
Excellent 10 (24.39%)
Good 20 (48.78%)
Fair 9 (21.95%)
Poor 2 (4.87%)
92% Substantial Improvement
in Pain
[Acta Orthopedica Hellenica, 2007]
www.shoulder.gr
50. Massive Rot Cuff TearsMassive Rot Cuff Tears
Definition:Definition:
• Involving 2 or more Tendon TearsInvolving 2 or more Tendon Tears (Gerber)(Gerber)
• >5cm Tear>5cm Tear (Cofield)(Cofield)
51. The problemThe problem
• Poor tendon qualityPoor tendon quality
• Muscle tendon retractionMuscle tendon retraction
• Muscular atrophy fatty infiltrationMuscular atrophy fatty infiltration
The three central issuesThe three central issues
• Passive range of motionPassive range of motion
• Tendon retractionTendon retraction
• Muscle viabilityMuscle viability
• Failure of healingFailure of healing
52. Techniques of releasesTechniques of releases
• The techniques adapted from openThe techniques adapted from open
surgery as described by Codmann,surgery as described by Codmann,
Rockwood, NeerRockwood, Neer
• Refined and modernized by Esch, Snyder,Refined and modernized by Esch, Snyder,
Gartsman, Burkhart and othersGartsman, Burkhart and others
53. ANY TYPE OF RECONSTRUCTIONANY TYPE OF RECONSTRUCTION
MUST AVOID TENSION OVER-LOADMUST AVOID TENSION OVER-LOAD
OF THE REPAIROF THE REPAIR
54. The solutionThe solution
• Improve the mechanical strength of theImprove the mechanical strength of the
repairrepair
• Enhance the biological responseEnhance the biological response
• Abandon and replace-muscle transferAbandon and replace-muscle transfer
• Rot cuff arthropathy-reverse or extendedRot cuff arthropathy-reverse or extended
head arthroplastyhead arthroplasty
55. Recognize the Tear PatternRecognize the Tear Pattern
• Tears must be repaired in theTears must be repaired in the
direction of greatest mobility ->direction of greatest mobility ->
minimal strainminimal strain
72. L-Shaped & U-Shaped TearsL-Shaped & U-Shaped Tears
Greater mobility from anterior toGreater mobility from anterior to
posterior than medial to lateralposterior than medial to lateral
73. L-Shaped & U-Shaped TearsL-Shaped & U-Shaped Tears
• Side to side sutures from medial to lateralSide to side sutures from medial to lateral
• Progressively converge the margin of theProgressively converge the margin of the
tear lateral to bone bedtear lateral to bone bed
• Closing 50% of a U-Shaped tear ->Closing 50% of a U-Shaped tear ->
reduces strain at converge margin by areduces strain at converge margin by a
factor of 6factor of 6
[[S. S .Burkhart]S. S .Burkhart]
74. 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
S. S .BurkhartS. S .Burkhart
75. Large U-shaped cuff tear
extending to glenoid
Margin convergence
The free margin of the cuff is
repaired to bone with suture
anchors
79. Massive Contracted Immobile TearsMassive Contracted Immobile Tears
• No mobility from medial to lateral or fromNo mobility from medial to lateral or from
anterior to posterioranterior to posterior
• Subcategories:Subcategories:
– Massive Contracted Longitudinal TearsMassive Contracted Longitudinal Tears
– Massive Contracted Crescent TearsMassive Contracted Crescent Tears
• Represent 9.6% of massive tearsRepresent 9.6% of massive tears
[[S.Burkhart]S.Burkhart]
80. Massive Contractite TearsMassive Contractite Tears
• Anterior Interval SlideAnterior Interval Slide
and/orand/or
• Posterior Interval SlidePosterior Interval Slide
Single and double interval slideSingle and double interval slide
82. Single and double interval slideSingle and double interval slide
• Anterior slide through release in theAnterior slide through release in the
rotator interval (supraspinatus–rotator interval (supraspinatus–
coracobrachialis)coracobrachialis)
• Posterior slide through release of thePosterior slide through release of the
interval supraspinatus-infraspinatusinterval supraspinatus-infraspinatus
89. Massive TearsMassive Tears
associated withassociated with
Subscapularis TearsSubscapularis Tears
• Subscapularis must be mobilized andSubscapularis must be mobilized and
repaired prior to the rest of the cuffrepaired prior to the rest of the cuff
• Interval slide in continuityInterval slide in continuity
94. Massive TearsMassive Tears
May beMay be
• Eassily repairableEassily repairable
• Retracted very difficult to repair (anterior &Retracted very difficult to repair (anterior &
posterior Slides)posterior Slides)
• Medially RepairedMedially Repaired
• Impossible to repairImpossible to repair
• Incomplete RepairIncomplete Repair
• Graft JacketsGraft Jackets
• Tendon trasfersTendon trasfers
• Reverse, extended head arthroplastyReverse, extended head arthroplasty
95. Arthroscopic cuff repairArthroscopic cuff repair
Wolf, Snyder, Gartsman, Esch,
Burkhart, Tauro and others reported
84%-94% excellent and good results
96. Results for massive tearsResults for massive tears
• 95% Good to Excellent Results95% Good to Excellent Results
independent to tear sizeindependent to tear size [Burkhart, 2001][Burkhart, 2001]
• With interval slideWith interval slide
• Improve UCLA score (10->28.3)Improve UCLA score (10->28.3)
• Improve Active ROM, StrengthImprove Active ROM, Strength
[Burkhart, 2004][Burkhart, 2004]
• Graft Jacket RepairGraft Jacket Repair
• Improve UCLA score (18->32Improve UCLA score (18->32))
[Snyder, 2008][Snyder, 2008]
97. ConclusionsConclusions
• Acute Crescent TearAcute Crescent Tear
Standard Techniques for tendon to bone fisxationStandard Techniques for tendon to bone fisxation
• U- or L- shaped TearsU- or L- shaped Tears
• Side to side margin convergenceSide to side margin convergence
• Partial mobile tearsPartial mobile tears
• Anterior / Posterior SlideAnterior / Posterior Slide
• Medialized RepairMedialized Repair
• Irreparable TearsIrreparable Tears
• Partial RepairPartial Repair
• GraftsGrafts
• Tendon trasfersTendon trasfers
98. What to do???What to do???
• Patients with grade 3 or 4 fatty degenerationPatients with grade 3 or 4 fatty degeneration
DO NOTDO NOT improve with rot cuff repairimprove with rot cuff repair
[Goutallier][Goutallier]
Vs.Vs.
• Patients with grade 3 or 4 fatty degenerationPatients with grade 3 or 4 fatty degeneration
improved significant at 86% of cases afterimproved significant at 86% of cases after
arthroscopic repairarthroscopic repair
[Burkhart][Burkhart]
99. In our experienceIn our experience
Patients withPatients with massivemassive rot cuff tearsrot cuff tears
benefitbenefit from surgeryfrom surgery
but they tend to recover slowlybut they tend to recover slowly
they succeed very good pain reliefthey succeed very good pain relief
but strength deficits remainbut strength deficits remain
100. In our experienceIn our experience
• Patients with upward migration of thePatients with upward migration of the
femoral head in contact with the acromionfemoral head in contact with the acromion
do not benefit from arthroscopydo not benefit from arthroscopy
• Patients with painless external rotation lagPatients with painless external rotation lag
and inability to keep the arm in externaland inability to keep the arm in external
rotation do not benefit from arthoscopyrotation do not benefit from arthoscopy
• With raised experience more previousWith raised experience more previous
irreparable cuff tears can be repairedirreparable cuff tears can be repaired
101.
102. 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)