Ian K.Y. Lo

Arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair is being performed by an increasing number of orthopaedic surgeons. The principles, techniques, and instrumentation have evolved to the extent that all patterns and sizes of rotator cuff tear, including massive tears, can now be repaired arthroscopically. Achieving a biomechanically stable construct is critical to biologic healing. The ideal repair construct must optimize suture-to-bone fixation, suture-to-tendon fixation, abrasion resistance of suture, suture strength, knot security, loop security, and restoration of the anatomic rotator cuff footprint (the surface area of bone to which the cuff tendons attach). By achieving optimized repair constructs, experienced arthroscopic surgeons are reporting results equal to those of open rotator cuff repair. As surgeons arthroscopic skill levels increase through attendance at surgical skills courses and greater experience gained in the operating room, there will be an increasing trend toward arthroscopic repair of most rotator cuff pathology.

Current Concepts in Arthroscopic Rotator Cuff Repair

The interest in arthroscopic rotator cuff repair has increased exponentially over the last 5 years. Although the operative technique of repair continues to evolve, there are now several studies reporting excellent results after arthroscopic repair of rotator cuff tears. In this review, we focus on new concepts and techniques related to arthroscopic rotator cuff repair that have been recently introduced.

Arthroscopic coracoplasty through the rotator interval

Coracoid impingement has been increasingly recognized as a cause of shoulder pain. Although most decompressive techniques involve open anterior surgery, the arthroscopic treatment of such impingement has only rarely been reported. In this report, the authors describe an intra-articular method of coracoplasty through the rotator interval. This method is easier to perform than a subacromial approach and allows appropriate orientation of the coracoplasty in the plane of the subscapularis tendon.

Subscapularis Tears: Arthroscopic Repair of the Forgotten Rotator Cuff Tendon

Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although more recent studies have focused on subscapularis tears, all have reported on techniques of open repair. The advent of arthroscopy and arthroscopic repair techniques has opened new frontiers for the diagnosis and repair of torn rotator cuff tendons, including the subscapularis. In this article, the authors review the senior authors surgical rationale, technique, and preliminary results of arthroscopic subscapularis repair.

The use of an intra-articular depth guide in the measurement of partial thickness rotator cuff tears.

Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears.