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PubMed2002

Differential arthroscopic portal placement for rotator cuff repair.

We report an effective technique of arthroscopic portal placement for rotator cuff repair of the shoulder. The differential portals are placed depending on the location of the tear. After the glenohumeral arthroscopic examination, the subacromial bursoscopy is performed through the same posterior skin portal. With the rotator cuff tear in view, a spinal needle is inserted to the center of the tear, 3 cm from the lateral margin of the acromion (middle working portal). Another spinal needle is then inserted into the posterior lip of the tear, 1 cm from the lateral margin of the acromion (rear viewing portal). The rear viewing portal provides a good downward en-face view of the tear, and the middle working portal allows better access to the anterior and posterior margins of the cuff tear than the usual posterior and lateral portals do. This differential portal placement with respect to the location of the rotator cuff tear ensures superior access for arthroscopic repair of rotator cuff tears.

Arthroscopy↗
PubMed2005

[Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect].

AIM: Although the outcome of surgical treatment of rotator cuff tears is well documented in the literature, less is known about the efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect. METHODS: A series of 30 patients (38 shoulders) with rotator cuff tears seen by ultrasonography were included in this prospective study. Rotator cuff tears were divided into partial defects (group A), full thickness tears of the supraspinatus tendon (group B), and massive rotator cuff defects (group C). Treatment consisted of a home program of stretching and strengthening exercises that were performed by the patients daily for a period of 12 weeks and controlled by a physician every 2 weeks. Range of motion, a modified constant score, and impingement signs at initial examination and after 12 weeks were compared. RESULTS: All groups experienced improvement in range of motion. The Constant scores improved significantly (p < 0.05) in all groups (A: 13.0 [+/- 7.9 SD], B: 13.2 [+/- 11.4 SD], and C: 17.5 [+/- 6.6 SD]). Impingement signs showed a downward trend in all groups. DISCUSSION: The results of this study show that patients with rotator cuff defects do benefit from simple home exercises independent from the size of the defect.

Adult↗
PubMed1998

Arthroscintigraphy in suspected rotator cuff rupture.

AIM: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. METHODS: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. RESULTS: In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. CONCLUSION: Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

Adult↗
PubMed2003

Rotator cuff repair with bioabsorbable screws: An in vivo and ex vivo investigation.

PURPOSE: The purpose of this study was to evaluate in vivo the clinical outcomes of rotator cuff repairs with bioabsorbable screws compared with metal suture anchors, and to compare the ex vivo initial load to failure of rotator cuff repairs using 3 different bioabsorbable screws, suture anchors, and transosseous sutures. TYPE OF STUDY: In vivo clinical outcomes investigation, and ex vivo biomechanical study. METHODS: Three cohorts of patients with rotator cuff tears that measured less than 4 cm(2), were sequentially repaired with Mitek Rotator Cuff QuickAnchors (Mitek Surgical Products, Norwood, MA) (n = 9), Arthrex Headed Bio-Corkscrews (n = 9) (Arthrex, Naples, FL), and Mitek Rotator Cuff QuickAnchors (n = 9). Patients were systematically assessed with a specific shoulder questionnaire and 23 shoulder tests performed preoperatively and at 1 and 6 weeks, 3 and 6 months, and 1 year postoperatively. A correlative ex vivo biomechanical study was performed on 53 ovine shoulders to evaluate the initial failure load properties of bioabsorbable screws compared with fixation with suture anchors and transosseous sutures. RESULTS: In the in vivo portion of the study, the cohort treated with the Headed Bio-Corkscrew demonstrated no improvement on any measured parameter until 1-year after rotator cuff repair. In contrast, shoulders repaired with Mitek Rotator Cuff QuickAnchors demonstrated improved overall shoulder function as early as 6 weeks postoperatively (P =.002), had a better constant score at 1-year after repair (88 +/- 9 v 73 +/- 17; P =.016), and a lower rate of revision rotator cuff repair (P =.029). In the ex vivo portion of the study, the bioabsorbable headed screws, Headed Bio-Corkscrew (100 +/- 30 N) and BioTwist (76 +/- 35 N), had inferior initial failure load properties compared with suture anchors (140 +/- 36 N) and transosseous sutures (147 +/- 68 N). In contrast, the BioCuff (190 +/- 56 N), a bioabsorbable implant that used a screw and serrated washer design, had equivalent initial failure load properties as the suture repairs. CONCLUSIONS: This investigation had poorer early outcomes, a lower shoulder functional score 1-year after repair, and a higher rate of repeat surgery in patients who had their rotator cuff repaired with a bioabsorbable screw than in patients who had their shoulders repaired with a standard metal suture anchor. Furthermore, the biomechanical testing demonstrated a lower tensile load to failure in the tendons repaired with a simple screw design compared to suture anchors with a mattress stitch. Of note, the implant that used a screw and washer design demonstrated a greater ability to resist initial tensile load.

Absorbable Implants↗
PubMed1994

Geometric and mechanical properties of the coracoacromial ligament and their relationship to rotator cuff disease.

One of the most common causes of pain and disability in the upper limb is inflammation of the rotator cuff tendons. When no significant bony abnormality exists in the surrounding structures, the coracoacromial ligament has been implicated as a possible cause of impingement on the cuff tendons. Geometric and mechanical properties of 20 coracoacromial ligaments, 10 from shoulders with rotator cuff tears and 10 from normal shoulders, were accurately determined. In comparing rotator cuff tear and normal specimens, statistically significant changes in geometric properties were measured in the lateral band, but not in the medial band, of the ligament. The lateral band, which is the region most likely to impinge on the rotator cuff, was shorter and had a larger cross-sectional area in specimens with rotator cuff tears. Although there were no statistical differences in structural properties of the ligament between normal and rotator cuff tear groups, significant changes were evident in material properties. Previously reported histologic differences in the ligament in shoulders with rotator cuff tears are supported by the decreased material properties measured in the current study. Whether the differences in the coracoacromial ligament cause impingement or are due to impingement is still unknown at this time.

Acromioclavicular Joint↗
PubMed2006

The effect of corticosteroid on collagen expression in injured rotator cuff tendon.

BACKGROUND: Subacromial corticosteroid injections are commonly used in the nonoperative management of rotator cuff disease. The effects of corticosteroid injection on injured rotator cuff tendons have not been studied. Our aims were to characterize the acute response of rotator cuff tendons to injury through the analysis of the type-III to type-I collagen expression ratio, a tendon injury marker, and to examine the effects of corticosteroid on this response. METHODS: Sixty Sprague-Dawley rats were randomly assigned to four groups: control, tendon injury, steroid treatment, and tendon injury and steroid treatment. Six rats served as sham controls. Unilateral tendon injuries were created with full-thickness defects across 50% of the total width of the infraspinatus tendon, 5 mm from its humeral insertion. Steroid treatment with a single dose of methylprednisolone (0.6 mg/kg), equivalent to that given to humans, was injected into the subacromial space under direct visualization. Steroid treatment followed the creation of an injury in the rats in the injury and steroid treatment group. At one, three, and five weeks after the injury, the total RNA isolated from tendons was quantified with real-time polymerase chain reaction with use of primers for type-I and type-III collagen and ribosomal 18s RNA. RESULTS: The type-III to type-I collagen expression ratio remained at baseline at all time-points in the control and sham groups. At one week, the type-III to type-I collagen expression ratio increased more than fourfold above the control level in the tendon injury group (p = 0.017) and the tendon injury and steroid treatment group (p = 0.003). The ratio remained greater than twofold above the control at three weeks in both groups (p = 0.003 and p = 0.037) and returned to baseline at five weeks. Interestingly, the group that had steroid treatment only showed an increase of >4.5-fold (p = 0.001) in the type-III to type-I collagen expression ratio, without structural injury to the tendon. This ratio returned to baseline levels by three weeks. CONCLUSIONS: A single dose of corticosteroid does not alter the acute phase response of an injured rotator cuff tendon in the rat. However, the same steroid dose in uninjured tendons initiates a short-term response equivalent to that of structural injury.

Animals↗
PubMedDate not supplied

Standard sonography and arthrosonography in the study of rotator cuff tears.

PURPOSE: The aim of this study was to evaluate the sensitivity of ultrasonography, integrating standard ultrasound and arthrosonography after injecting a saline solution into the glenohumeral cavity in cases of suspected rotator cuff tears. MATERIALS AND METHODS: We prospectively examined 40 patients awaiting shoulder arthroscopy for suspected or diagnosed tears of the rotator cuff. A radiologist, unaware of the pre-operative diagnosis, performed an ultrasound scan on all the patients before and after the injection of saline solution into the glenohumeral cavity. The parameters considered were presence or absence of a rotator cuff injury; type of injury according to Snyder and its extent along the longitudinal and transverse planes; presence or absence of effusion into the articular cavity; subacromial/subdeltoid bursal distension. All the patients underwent arthroscopy either the same day or the day after the ultrasound examination. RESULTS: Standard sonography showed 26 complete rotator cuff tears (type C according to Snyder), 2 partial tears (type B according to Snyder) and 12 intact rotator cuffs. Arthrosonography detected 31 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs.Arthroscopy identified 32 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs. Analysis of the results shows that, taking arthroscopy as the gold standard, the sensitivity of normal sonography is 81.2%, whereas that of arthrosonography is 96.8% (p < 0.05). CONCLUSIONS: On the basis of the data obtained in this study, standard sonography, integrated with the injection of a saline solution into the glenohumeral cavity, considerably increases the diagnostic sensitivity for rotator cuff tears. The authors suggest that arthrosonography can be used in the event of suspected rotator cuff tears, when MRI is contraindicated.

Adult↗
PubMed2005

Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography.

OBJECTIVES: Reliable assessment of fatty degeneration of rotator cuff muscles is desirable to predict the outcome of shoulder surgery. Currently used qualitative assessments are limited by relatively high inter- and intraobserver variability. It was hypothesized that a quantitative measurement of muscle density using computed tomography (CT) was more reliable and reproducible. MATERIALS AND METHODS: Thirty shoulders from patients with rheumatoid arthritis were analyzed using parasagittal multiplanar reconstructions acquired from a 16-slice CT scanner. Three observers visually rated the severity of fatty degeneration and independently outlined the rotator cuff muscles, after which the mean density was calculated. Inter- and intraobserver agreement on both measurements was expressed by the interclass correlation coefficient (ICC) and the standard deviation of the differences (SDD) between the measurements. RESULTS: A strong correlation was found between the quantitative measure and the visual rating (R2 = 0.94; P < 0.0001). The SDD in muscle density did not exceed 2.3 Hounsfield units, and the mean rotator cuff ICC (0.98) was substantially greater than that of the visual rating (0.63). CONCLUSIONS: This study describes a reproducible method to quantify fatty degeneration of the rotator cuff muscles in CT images, with a higher interobserver agreement than the visual score, and may prove a reliable tool to evaluate the quality of the rotator cuff muscles.

Adipose Tissue↗
PubMed2000

Clinical outcome after structural failure of rotator cuff repairs.

BACKGROUND: The clinical outcome for patients with documented rerupture after open repair of one or more rotator cuff tendons is not well known. The purpose of this study was to evaluate the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to provide information concerning the advisability of rotator cuff repair in situations in which there may be a high probability of rerupture. METHODS: During prospective follow-up after rotator cuff repairs, we detected, with magnetic resonance imaging, structural failure of the repair in twenty patients, who had a mean age of fifty-nine years at the time of the rotator cuff repair. All patients were clinically examined for the purpose of this report at a mean of thirty-eight months. RESULTS: The reruptures invariably involved the originally torn tendon but were smaller than the original tear in sixteen of the twenty patients. Fatty degeneration of the supraspinatus and infraspinatus muscles, atrophy of the supraspinatus muscle, and glenohumeral osteoarthritis progressed significantly from the preoperative state (p < 0.05). At the time of the most recent follow-up, the subjective shoulder value averaged 75 percent of the value for a normal shoulder. Eleven patients were very satisfied with the result, six were satisfied, two were disappointed, and one was dissatisfied. The mean relative score according to the system of Constant and Murley had increased from 49 percent of the score for a normal shoulder preoperatively to 83 percent postoperatively (p = 0.0001). Pain had decreased significantly, and the ranges of active, pain-free forward elevation and abduction as well as the abduction strength had improved significantly (p < 0.05). The clinical outcome was significantly correlated with the size of the postoperative tear, the stage of postoperative fatty muscle degeneration of the infraspinatus and subscapularis, the postoperative acromiohumeral distance, and the degree of postoperative glenohumeral osteoarthritis (p < 0.05). CONCLUSIONS: This study documents that an attempt at rotator cuff repair significantly decreases pain (p = 0.0026) and significantly improves function (p = 0.0005) and strength (p = 0.0137) even if magnetic resonance imaging documents that the repair has failed. This finding suggests that the potential for rerupture should not be considered a formal contraindication to an attempt at repair if optimal functional recovery is the goal of treatment.

Aged↗
PubMed2000

Surgical treatment of full thickness rotator cuff tear in patients younger than 40 years.

BACKGROUND: Full thickness tear of the rotator cuff is a well-known entity in the middle-aged and elderly population and the results of surgical repair are well documented. Rotator cuff tear in patients under the age of 40 years is unusual and the cause and treatment are not well established. The present study reports 12 young patients with full thickness tear of the rotator cuff treated surgically. METHODS: Open anteroinferior acromioplasty and cuff repairs were performed on every patient after failure of nonsurgical treatment. The average follow-up was 59.5 months (range, 36-100 months). RESULTS: The average patient age at the time of surgery was 30.2 years (range, 17-39 years). Symptoms included pain and dysfunction in all patients and weakness in eight patients. The duration of symptoms before surgery ranged from 6 to 60 months (average, 22.8 months). Ten patients were able to return to their preinjury status within an average of 4.5 months (range, 3-9 months) after surgery. Three athletes were able to return to previous levels of competition. Nine patients had excellent functional results with regard to pain, motion, strength, function and satisfaction. Eleven patients were satisfied with the operation and had significant pain reduction compared with their preoperative status. CONCLUSIONS: An acute traumatic event was the etiology of the rotator cuff tears in this study. The results of surgical treatment in this younger group of patients were satisfactory and were comparable to the outcomes reported for surgical treatment of rotator cuff tears in older patients and athletes.

Adolescent↗
PubMedDate not supplied

Rotator cuff repair in spinal cord injury patients.

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on nonsurgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord-injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging underwent rotator cuff repair. Two of eight shoulders were revisions. The patients were evaluated postoperatively with the American Shoulder and Elbow Surgeons Scoring System. These results were compared with preoperative functional assessment. Patients were given a subjective questionnaire to assess their overall experience. Postoperative range of motion improved in 6 of 8 shoulders. Strength was increased in 6 of 8 shoulders. Patients reported satisfaction with the results in 7 of 8 shoulders, and all 5 patients would recommend the procedure to other spinal cord injury patients. At recent follow-up, 7 of 8 shoulders returned to their preinjury level of function. Surgery for spinal cord injury patients with rotator cuff tears can improve their functional capability and autonomy while reducing their pain. Compliance with the demanding postoperative rehabilitation is essential; therefore proper patient selection is crucial for optimal results.

Adult↗
PubMed2003

Etiology, classification and clinical evaluation of partial-thickness tears of rotator cuff.

Since partial-thickness tears of the rotator cuff were described well by Codman in 1934, they have been extensively discussed in all kinds of literatures. Partial-thickness tears of the rotator cuff are now considered to play a more significant role than previously in inducing patients' disability. Partial-thickness cuff tears deserve more clinical attention. Both accurate diagnosis and proper surgical repair are very essential. The cognition of partial-thickness tears has been deepened in the last decades. In this paper we will review the etiology, classification and clinical evaluation of partial-thickness tears of the rotator cuff.

Diagnosis, Differential↗
PubMed2006

Gender differences in quality of life and extent of rotator cuff pathology.

PURPOSE: The purpose of this study was to investigate the effect of age and gender on functional and emotional status and extent of rotator cuff and associated pathology in patients undergoing arthroscopic surgery. TYPE OF STUDY: Historical cohort study. METHODS: This study involved 279 patients who underwent rotator cuff decompression or rotator cuff repair and for whom scores for the 5 domains of a preoperative rotator cuff outcome measure were available. Arthroscopic examination was used to identify the extent of pathology in the rotator cuff, biceps tendon, and superior labrum. RESULTS: Over a period of 3 years, 108 women and 171 men underwent surgery. There was a statistically significant difference in the domain of emotions (P = .024) for men and women. The levels of symptoms (P = .020), difficulty with performing sports and recreational activities (P = .043), and emotions (P = .001) were significantly different between individuals under 55 years of age and those 55 and older, with older patients reporting less difficulty. In terms of extent of pathology, the chi-square analysis showed a statistically significant difference in the incidence of full-thickness tears (P < .0001) between different age groups and SLAP lesions types II to IV (P = .009) between men and women. CONCLUSIONS: Female candidates for rotator cuff-related surgeries report more emotional difficulties. Older age group appear to have less functional and emotional disability despite an increase in the prevalence of major rotator cuff pathology. Gender and age have important roles on quality of life and extent of shoulder pathology. LEVEL OF EVIDENCE: Level II, investigating the outcome of disease.

Age Factors↗
PubMed1999

[Pathology of the rotator cuff].

In daily practice painful shoulder is frequent. Rotator cuff pathology (traumatic, microtraumatic or both) is frequently involved. Treatment is closely related to diagnosis, which directly depends on features given by the triad "questioning, clinical exam, standard X-rays". In some very precise cases this triad will be completed by more complex exams (arthro CT, MRI). Rotator cuff pathology is diversified: either tendinopathies (calcifying or not) or tears (partial or transfixiant). Rotator cuff tear's natural evolution is a slow aggravation to a final subacromial arthrosis or an excentrated omarthrosis in a certain term which tolerance may vary.

Diagnosis, Differential↗
PubMedDate not supplied

The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears.

We measured the incidence of cuff retear and injury to the suprascapular nerve after mobilization and repair of a massive rotator cuff tear. Of one hundred four rotator cuff repairs performed over a 5-year period, 10 patients (7 men and 3 women, age range 22 to 68 years) had primary repairs of massive rotator cuff tears requiring cuff mobilization and an acromioplasty as their only procedure. These patients were evaluated at a mean of 2.5 years (range 2.0 to 3.0 years) after surgery. At follow-up electromyographic examination confirmed that 1 of the 10 patients had an iatrogenic suprascapular nerve injury, whereas ultrasound evaluation revealed that 2 of 10 repairs failed. Pain relief was achieved in the eight patients with intact repairs and not in the two with recurrent tears. All patients had some limitation of active motion or strength, especially in external rotation. Thus 7 of 10 patients had neither evidence of nerve injury nor recurrent rotator cuff tears yet still showed limited active motion or weakness. It appears that operative injury to the suprascapular nerve during cuff mobilization can occur, but other factors such as inadequate cuff muscle function are more frequently responsible for the poor functional outcomes seen after successful repairs of massive rotator cuff tears.

Adult↗
PubMed2005

Changes in the long head of the biceps tendon in rotator cuff tear shoulders.

BACKGROUND: Morphologic changes in the long head of the biceps tendon have been described in association with rotator cuff disease, yet mechanical significance of these changes remains unclear. METHODS: An experiment was designed to test the hypotheses that the cross-sectional area and material properties of the long head of the biceps tendon are different in shoulders with full thickness rotator cuff tears and shoulders with intact rotator cuff tendons. Seven pairs of cadaver shoulders were tested. In each pair one shoulder had a full thickness rotator cuff tear and the other did not. Thus, a matched design was used. Cross sectional areas were measured. Tendon material properties were measured using an optical strain system. FINDINGS: We were unable to detect a statistically significant difference in the long head of the biceps area or material properties between tendons in shoulders with and without rotator cuff tears. An a priori power analysis was conducted indicating the sample size was sufficient to detect a difference of 70 MPa in the elastic modulus measurement. INTERPRETATION: Our data indicate there is no difference in the long head of the biceps cross sectional area or material properties. Therefore, the long head of the biceps tendon appears to retain its material properties in the presence of a rotator cuff tear. The clinical significance of this finding is that the long head of the biceps can be retained in the presence of a rotator cuff tear without concern that mechanical properties have substantially deteriorated.

Anatomy, Cross-Sectional↗
PubMed2001

Shoulder MRI refinements: differentiation of rotator cuff tear from artifacts and tendonosis, and reassessment of normal findings.

One of the difficulties with rotator cuff imaging lies in the normal variability of the tendon's signal. There may be intermediate signal present within the tendon because of magic-angle phenomenon, muscle and tendon fiber interdigitation, or tendinopathy related to degenerative changes or overuse injury. Partial and complete rotator cuff tears should be distinguishable from these causes of intermediate signal if water signal is reliably identified. This article reviews the important issue of distinguishing between rotator cuff tear and other causes of high signal in the rotator cuff, including artifacts and tendonosis. We include a review of the literature and a brief report of a study we conducted on 20 shoulders of 14 asymptomatic, young volunteers. In this study, the rotator cuff tendons were evaluated for abnormal signal at different TE values to determine at what TE the interpreters were able to confidently distinguish the high-signal intensity of a tear (water) from the intermediate signal intensity associated with artifact and tendinopathy. Readers were able to distinguish water and tendon signal in 70% to 100% of fast-spin echo (FSE) fat-saturated images with TE of 66, but there was interobserver variability at this TE, suggesting that it is less reliable than 88 ms in the identification of rotator cuff tears. By using FSE fat-saturated sequences with TE of 88 and fast spin echo inversion recovery (FSEIR) sequences, readers at all levels of experience were able to differentiate water signal intensity from tendon signal intensity in 100% of cases. Therefore, we suggest that either FSEIR images or FSE fat-saturated images with TE greater than 66 be used to facilitate the differentiation of fluid signal from intermediate increased signal intensity in rotator cuff imaging. Additionally, this article reviews the normal findings of shoulder magnetic resonance imaging (MRI) as revealed by the asymptomatic subjects included in our study, and assesses these findings in respect to previous publications. The normal features reviewed include the subacromion-subdeltoid (SA/SD) bursa, the biceps tendon sheath, the acromioclavicular (AC) joint, and the greater tuberosity of the humerus. A small amount of fluid was commonly seen in the SA/SD bursa, as well as the biceps tendon sheath. Subjective down-sloping of the acromion in the coronal plane, mild degenerative change of the AC joint, and undersurface spurring of the AC joint were uncommon in our normal subjects. Cystic change limited to the posterior aspect of the greater tuberosity was identified in 15% to 45% of shoulders.

Artifacts↗
PubMed2002

Arthroscopic transhumeral rotator cuff repair: Giant needle technique.

An arthroscopic transhumeral rotator cuff repair technique is presented with which the same type of cuff repair can be performed as with an open standard procedure. After adequate arthroscopic subacromial decompression, a bone trough is made on the greater tuberosity and a hole is punctured with a sharp hook. A special bone-cutting needle with a suture (giant needle) is then passed through the skin and deltoid muscle in front of the acromion, through the torn tendon, the hole in the trough, and out through the lateral cortical surface through the deltoid and skin. The suture limbs are pulled out through the instrumentation portal and a sliding knot is made to close the defect. No hardware implants are used and the procedure is not technically complicated. During surgery only two thirds of the steps used for open repair were required. With experience, a large tear was repaired as well as with an open repair. The advantages of this technique are that the strength of cuff fixation does not rely on the quality of the bone in the greater tuberosity, there is no need for complicated suture passing techniques through the rotator cuff, and it offers the same fixation technique as the traditional open repair.

Adult↗