Arthroscopic Rotator Cuff Repair

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Partial-thickness rotator cuff tears, failed conservative treatment
  • Full-thickness rotator cuff tears
CONTRAINDICATIONS
  • Lack of surgeon familiarity with arthroscopic repair techniques
  • Low-demand patients with functional rotator cuff tears
  • Patients who require pain relief only
  • Patient unwillingness to comply with the rigorous postoperative rehabilitation program
  • Severe rotator cuff tear (rotator cuff arthropathy)
EQUIPMENT
  • Arthroscopy tower and equipment
  • Shoulder arthroscopy set
  • Suture passers/retrievers
  • Suture
  • Spinal needles
  • Suture hooks and shuttles
  • Arthroscopic knot pushers
  • Caspari suture punch (Biomet Sports Medicine, Inc, Warsaw, Ind)
  • Anchors
  • Bone punch
  • Tendon graspers
  • Arthroscopic elevators
  • Sling
  • Pain pump (optional)
ANATOMY
  • Supraspinatus muscle
    • Arises from supraspinatus fossa of scapula
    • Inserts into superior portion of greater tuberosity
    • Innervated by suprascapular nerve (C5)
    • Supplied by suprascapular artery (branch of the thyrocervical artery, which arises from subclavian artery)
  • Infraspinatus muscle
    • Arises from infraspinatus fossa of scapula
    • Inserts into middle portion of greater tuberosity
    • Innervated by suprascapular nerve (C5)
    • Supplied by suprascapular artery and circumflex scapular artery (branch of the subscapular artery)
    • Teres minor muscle
      • Arises from lateral scapula
      • Inserts into inferior portion of greater tuberosity
      • Innervated by axillary nerve
      • Supplied by circumflex scapular artery and posterior circumflex humeral artery (branch of the axillary artery)
      • Subscapularis muscle
        • Arises from subscapular fossa of scapula
        • Inserts into lesser tuberosity of humerus
        • Innervated by upper and lower subscapular nerve
        • Supplied by the circumflex scapular artery, the dorsal scapular artery, the suprascapular artery, and lateral thoracic artery
        • These muscles arise from the scapula, and their tendons blend with the adjacent shoulder capsule as they attach to the tuberosities of the humerus.
          • The infraspinatus and teres minor fuse near their musculotendinous junctions.
          • The supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove.
          • The footprint has a mean minimal medial-to-lateral width of 14.7 mm. The mean medial-to-lateral insertion widths and anteroposterior distances vary by tendon.
            • Supraspinatus: 12.7 mm and 16.3 mm
            • Infraspinatus: 13.4 mm and 16.4 mm
            • Teres minor: 11.4 mm and 20.7 mm
            • Subscapularis: 17.9 mm and 24.3 mm
          • The mean anteroposterior distances of the supraspinatus, infraspinatus, teres minor, and subscapularis insertions were noted to be 1.63, 1.64, 2.07, and 2.43 cm, respectively.
          • Rotator cuff function includes rotating the humerus with respect to the scapula, compressing the humeral head into the glenoid fossa, and providing muscular balance.
          • The concavity-compression effect and mechanical depression of the humeral head counteract the superiorly directed force produced by the deltoid.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Rotator Interval Capsule Closure (Treacy, Field, and Savoie)
  • Post-Procedure: Arthroscopic Side-to-Side Repair of Delamination Tears and Localized Partial-Thickness Articular-Side Cuff Tears
  • Post-Procedure: Arthroscopic Repair of Complete Rotator Cuff Tears
  • Post-Procedure: Repair of Large or Massive Contracted Tears Using the Interval Slide Technique (Tauro et al)
  • Post-Procedure: Subscapularis Tendon Repair

Post-Procedure: Rotator Interval Capsule Closure (Treacy, Field, and Savoie)

POST-PROCEDURE CARE
  • Immobilize in a sling for 3 to 6 weeks.
  • Avoid overhead motion or external rotation beyond neutral for 6 weeks.
  • Begin overhead motion at 6 weeks postoperatively.
  • Begin resisted isotonic strengthening at 10 weeks.
  • If the tear was small, an accelerated rehabilitation program may be used.
  • Progressive activities are incorporated as strength allows, and unrestricted activities usually are resumed 6 to 12 months after surgery.
COMPLICATIONS
  • Infection
  • Postoperative stiffness
  • Failure of repair
  • Complex regional pain syndrome
  • Deep vein thrombosis.
ANALYSIS OF RESULTS

Arthroscopic repair has results and complication rates that are similar to those of open and mini-open techniques for partial to small full-thickness rotator cuff tears, but with lower gains in strength and motion and higher rates of recurrence for very large and massive tears.

OUTCOMES AND EVIDENCE
  • Brislin, Field, and Savoie: 11% complication rate for primary arthroscopic rotator cuff repair, including shoulder stiffness, failure of healing, infections, complex regional pain syndrome, and deep venous thrombosis
  • Cole et al: significant improvements in all outcome measures; 22% recurrence of tear, which correlated with patient age and extension of the tear to the supraspinatus
  • Kang et al: arthroscopic versus mini-open treatment of chronic small and medium rotator cuff tears; found that early functional outcomes were nearly equivalent, but the arthroscopic group had statistically significant improvement in pain scores at 3 months
  • Deutsch: 98% satisfaction with arthroscopic repair of partial-thickness (>50% thickness) tears
  • Verma et al: no statistical difference in outcome of arthroscopic repair versus mini-open repair
  • Lafosse et al: failure rate of 11% with arthroscopic rotator cuff repair, lower with double-row than single-row fixation.
  • Franceschi et al: comparable clinical results between single-row and double-row fixation techniques at 2-year follow-up
  • Huijsmans et al: 91% excellent or good outcome after arthroscopic rotator cuff repair with double-row fixation
  • Charousset et al: better tendon healing rates with double-row fixation, but no difference in clinical results.
  • Ma et al: cadaver study showed higher ultimate tensile load of double-row fixation compared to three different types of single-row fixation.
  • Andrews et al: 85% good and excellent results with arthroscopic debridement alone in young athletes
  • Budoff et al: 89% good to excellent results after arthroscopic debridement alone for partial-thickness rotator cuff tears at 5 years follow-up; this decreased to 81% after five years.
  • Esch: 76% with partial tears had satisfactory results with arthroscopic debridement and subacromial decompression.
  • Cordasco et al: no difference in outcome of arthroscopic acromioplasty and debridement in patients with partial-thickness rotator cuff tears compared to those without tear.
  • Weber: partial-thickness tears treated with arthroscopic debridement and acromioplasty versus arthroscopic acromioplasty and mini-open repair; the debridement and acromioplasty group had 14 good and no excellent results; the repair group had 28 good and 3 excellent results.
Procedure: Rotator Interval Capsule Closure (Treacy, Field, and Savoie)

Post-Procedure: Arthroscopic Side-to-Side Repair of Delamination Tears and Localized Partial-Thickness Articular-Side Cuff Tears

POST-PROCEDURE CARE
  • Immobilize in a sling for 3 to 6 weeks.
  • Avoid overhead motion or external rotation beyond neutral for 6 weeks.
  • Begin overhead motion at 6 weeks postoperatively.
  • Begin resisted isotonic strengthening at 10 weeks.
  • If the tear was small, an accelerated rehabilitation program may be used.
  • Progressive activities are incorporated as strength allows, and unrestricted activities usually are resumed 6 to 12 months after surgery.
COMPLICATIONS
  • Infection
  • Postoperative stiffness
  • Failure of repair
  • Complex regional pain syndrome
  • Deep vein thrombosis.
ANALYSIS OF RESULTS

Arthroscopic repair has results and complication rates that are similar to those of open and mini-open techniques for partial to small full-thickness rotator cuff tears, but with lower gains in strength and motion and higher rates of recurrence for very large and massive tears.

OUTCOMES AND EVIDENCE
  • Brislin, Field, and Savoie: 11% complication rate for primary arthroscopic rotator cuff repair, including shoulder stiffness, failure of healing, infections, complex regional pain syndrome, and deep venous thrombosis
  • Cole et al: significant improvements in all outcome measures; 22% recurrence of tear, which correlated with patient age and extension of the tear to the supraspinatus
  • Kang et al: arthroscopic versus mini-open treatment of chronic small and medium rotator cuff tears; found that early functional outcomes were nearly equivalent, but the arthroscopic group had statistically significant improvement in pain scores at 3 months
  • Deutsch: 98% satisfaction with arthroscopic repair of partial-thickness (>50% thickness) tears
  • Verma et al: no statistical difference in outcome of arthroscopic repair versus mini-open repair
  • Lafosse et al: failure rate of 11% with arthroscopic rotator cuff repair, lower with double-row than single-row fixation.
  • Franceschi et al: comparable clinical results between single-row and double-row fixation techniques at 2-year follow-up
  • Huijsmans et al: 91% excellent or good outcome after arthroscopic rotator cuff repair with double-row fixation
  • Charousset et al: better tendon healing rates with double-row fixation, but no difference in clinical results.
  • Ma et al: cadaver study showed higher ultimate tensile load of double-row fixation compared to three different types of single-row fixation.
  • Andrews et al: 85% good and excellent results with arthroscopic debridement alone in young athletes
  • Budoff et al: 89% good to excellent results after arthroscopic debridement alone for partial-thickness rotator cuff tears at 5 years follow-up; this decreased to 81% after five years.
  • Esch: 76% with partial tears had satisfactory results with arthroscopic debridement and subacromial decompression.
  • Cordasco et al: no difference in outcome of arthroscopic acromioplasty and debridement in patients with partial-thickness rotator cuff tears compared to those without tear.
  • Weber: partial-thickness tears treated with arthroscopic debridement and acromioplasty versus arthroscopic acromioplasty and mini-open repair; the debridement and acromioplasty group had 14 good and no excellent results; the repair group had 28 good and 3 excellent results.
Procedure: Arthroscopic Side-to-Side Repair of Delamination Tears and Localized Partial-Thickness Articular-Side Cuff Tears

Post-Procedure: Arthroscopic Repair of Complete Rotator Cuff Tears

POST-PROCEDURE CARE
  • Immobilize in a sling for 3 to 6 weeks.
  • Avoid overhead motion or external rotation beyond neutral for 6 weeks.
  • Begin overhead motion at 6 weeks postoperatively.
  • Begin resisted isotonic strengthening at 10 weeks.
  • If the tear was small, an accelerated rehabilitation program may be used.
  • Progressive activities are incorporated as strength allows, and unrestricted activities usually are resumed 6 to 12 months after surgery.
COMPLICATIONS
  • Infection
  • Postoperative stiffness
  • Failure of repair
  • Complex regional pain syndrome
  • Deep vein thrombosis.
ANALYSIS OF RESULTS

Arthroscopic repair has results and complication rates that are similar to those of open and mini-open techniques for partial to small full-thickness rotator cuff tears, but with lower gains in strength and motion and higher rates of recurrence for very large and massive tears.

OUTCOMES AND EVIDENCE
  • Brislin, Field, and Savoie: 11% complication rate for primary arthroscopic rotator cuff repair, including shoulder stiffness, failure of healing, infections, complex regional pain syndrome, and deep venous thrombosis
  • Cole et al: significant improvements in all outcome measures; 22% recurrence of tear, which correlated with patient age and extension of the tear to the supraspinatus
  • Kang et al: arthroscopic versus mini-open treatment of chronic small and medium rotator cuff tears; found that early functional outcomes were nearly equivalent, but the arthroscopic group had statistically significant improvement in pain scores at 3 months
  • Deutsch: 98% satisfaction with arthroscopic repair of partial-thickness (>50% thickness) tears
  • Verma et al: no statistical difference in outcome of arthroscopic repair versus mini-open repair
  • Lafosse et al: failure rate of 11% with arthroscopic rotator cuff repair, lower with double-row than single-row fixation.
  • Franceschi et al: comparable clinical results between single-row and double-row fixation techniques at 2-year follow-up
  • Huijsmans et al: 91% excellent or good outcome after arthroscopic rotator cuff repair with double-row fixation
  • Charousset et al: better tendon healing rates with double-row fixation, but no difference in clinical results.
  • Ma et al: cadaver study showed higher ultimate tensile load of double-row fixation compared to three different types of single-row fixation.
  • Andrews et al: 85% good and excellent results with arthroscopic debridement alone in young athletes
  • Budoff et al: 89% good to excellent results after arthroscopic debridement alone for partial-thickness rotator cuff tears at 5 years follow-up; this decreased to 81% after five years.
  • Esch: 76% with partial tears had satisfactory results with arthroscopic debridement and subacromial decompression.
  • Cordasco et al: no difference in outcome of arthroscopic acromioplasty and debridement in patients with partial-thickness rotator cuff tears compared to those without tear.
  • Weber: partial-thickness tears treated with arthroscopic debridement and acromioplasty versus arthroscopic acromioplasty and mini-open repair; the debridement and acromioplasty group had 14 good and no excellent results; the repair group had 28 good and 3 excellent results.
Procedure: Arthroscopic Repair of Complete Rotator Cuff Tears

Post-Procedure: Repair of Large or Massive Contracted Tears Using the Interval Slide Technique (Tauro et al)

POST-PROCEDURE CARE
  • Immobilize in a sling for 3 to 6 weeks.
  • Avoid overhead motion or external rotation beyond neutral for 6 weeks.
  • Begin overhead motion at 6 weeks postoperatively.
  • Begin resisted isotonic strengthening at 10 weeks.
  • If the tear was small, an accelerated rehabilitation program may be used.
  • Progressive activities are incorporated as strength allows, and unrestricted activities usually are resumed 6 to 12 months after surgery.
COMPLICATIONS
  • Infection
  • Postoperative stiffness
  • Failure of repair
  • Complex regional pain syndrome
  • Deep vein thrombosis.
ANALYSIS OF RESULTS

Arthroscopic repair has results and complication rates that are similar to those of open and mini-open techniques for partial to small full-thickness rotator cuff tears, but with lower gains in strength and motion and higher rates of recurrence for very large and massive tears.

OUTCOMES AND EVIDENCE
  • Brislin, Field, and Savoie: 11% complication rate for primary arthroscopic rotator cuff repair, including shoulder stiffness, failure of healing, infections, complex regional pain syndrome, and deep venous thrombosis
  • Cole et al: significant improvements in all outcome measures; 22% recurrence of tear, which correlated with patient age and extension of the tear to the supraspinatus
  • Kang et al: arthroscopic versus mini-open treatment of chronic small and medium rotator cuff tears; found that early functional outcomes were nearly equivalent, but the arthroscopic group had statistically significant improvement in pain scores at 3 months
  • Deutsch: 98% satisfaction with arthroscopic repair of partial-thickness (>50% thickness) tears
  • Verma et al: no statistical difference in outcome of arthroscopic repair versus mini-open repair
  • Lafosse et al: failure rate of 11% with arthroscopic rotator cuff repair, lower with double-row than single-row fixation.
  • Franceschi et al: comparable clinical results between single-row and double-row fixation techniques at 2-year follow-up
  • Huijsmans et al: 91% excellent or good outcome after arthroscopic rotator cuff repair with double-row fixation
  • Charousset et al: better tendon healing rates with double-row fixation, but no difference in clinical results.
  • Ma et al: cadaver study showed higher ultimate tensile load of double-row fixation compared to three different types of single-row fixation.
  • Andrews et al: 85% good and excellent results with arthroscopic debridement alone in young athletes
  • Budoff et al: 89% good to excellent results after arthroscopic debridement alone for partial-thickness rotator cuff tears at 5 years follow-up; this decreased to 81% after five years.
  • Esch: 76% with partial tears had satisfactory results with arthroscopic debridement and subacromial decompression.
  • Cordasco et al: no difference in outcome of arthroscopic acromioplasty and debridement in patients with partial-thickness rotator cuff tears compared to those without tear.
  • Weber: partial-thickness tears treated with arthroscopic debridement and acromioplasty versus arthroscopic acromioplasty and mini-open repair; the debridement and acromioplasty group had 14 good and no excellent results; the repair group had 28 good and 3 excellent results.
Procedure: Repair of Large or Massive Contracted Tears Using the Interval Slide Technique (Tauro et al)
Post-Procedure: Subscapularis Tendon Repair
POST-PROCEDURE CARE
  • Immobilize in a sling for 3 to 6 weeks.
  • Avoid overhead motion or external rotation beyond neutral for 6 weeks.
  • Begin overhead motion at 6 weeks postoperatively.
  • Begin resisted isotonic strengthening at 10 weeks.
  • If the tear was small, an accelerated rehabilitation program may be used.
  • Progressive activities are incorporated as strength allows, and unrestricted activities usually are resumed 6 to 12 months after surgery.
COMPLICATIONS
  • Infection
  • Postoperative stiffness
  • Failure of repair
  • Complex regional pain syndrome
  • Deep vein thrombosis.
ANALYSIS OF RESULTS

Arthroscopic repair has results and complication rates that are similar to those of open and mini-open techniques for partial to small full-thickness rotator cuff tears, but with lower gains in strength and motion and higher rates of recurrence for very large and massive tears.

OUTCOMES AND EVIDENCE
  • Brislin, Field, and Savoie: 11% complication rate for primary arthroscopic rotator cuff repair, including shoulder stiffness, failure of healing, infections, complex regional pain syndrome, and deep venous thrombosis
  • Cole et al: significant improvements in all outcome measures; 22% recurrence of tear, which correlated with patient age and extension of the tear to the supraspinatus
  • Kang et al: arthroscopic versus mini-open treatment of chronic small and medium rotator cuff tears; found that early functional outcomes were nearly equivalent, but the arthroscopic group had statistically significant improvement in pain scores at 3 months
  • Deutsch: 98% satisfaction with arthroscopic repair of partial-thickness (>50% thickness) tears
  • Verma et al: no statistical difference in outcome of arthroscopic repair versus mini-open repair
  • Lafosse et al: failure rate of 11% with arthroscopic rotator cuff repair, lower with double-row than single-row fixation.
  • Franceschi et al: comparable clinical results between single-row and double-row fixation techniques at 2-year follow-up
  • Huijsmans et al: 91% excellent or good outcome after arthroscopic rotator cuff repair with double-row fixation
  • Charousset et al: better tendon healing rates with double-row fixation, but no difference in clinical results.
  • Ma et al: cadaver study showed higher ultimate tensile load of double-row fixation compared to three different types of single-row fixation.
  • Andrews et al: 85% good and excellent results with arthroscopic debridement alone in young athletes
  • Budoff et al: 89% good to excellent results after arthroscopic debridement alone for partial-thickness rotator cuff tears at 5 years follow-up; this decreased to 81% after five years.
  • Esch: 76% with partial tears had satisfactory results with arthroscopic debridement and subacromial decompression.
  • Cordasco et al: no difference in outcome of arthroscopic acromioplasty and debridement in patients with partial-thickness rotator cuff tears compared to those without tear.
  • Weber: partial-thickness tears treated with arthroscopic debridement and acromioplasty versus arthroscopic acromioplasty and mini-open repair; the debridement and acromioplasty group had 14 good and no excellent results; the repair group had 28 good and 3 excellent results.
Procedure: Subscapularis Tendon Repair
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