Transcript Applied Anatomy for Arthroscopic Rotator Cuff Repair

Principles of Arthroscopic
Rotator Cuff Repair
Edward Tillett, M.D.
Department of Orthopedic Surgery
University of Louisville
Principles of Arthroscopic
Rotator Cuff Repair
Adequate Visualization
Rotator cuff preparation prior to repair
Appropriate portal placement for suture
passage and suture anchor placement
Secure knot tying
Adequate Visualization
Techniques to minimize bleeding
Adequate subacromial bursectomy
Subacromial decompression
Techniques to Minimize Bleeding
Adequate distension of subacromial space
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Gravity inflow or arthroscopic pump
Anaesthesia to keep blood pressure
normotensive or below
Adequate Subacromial Bursectomy
Anatomy of subacromial bursa
Adequate Subacromial Bursectomy
The bursectomy needs to be anterior,
posterior, distal.

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Must see the entire rotator cuff
Must see the insertion of the rotator cuff onto
greater tuberosity
Resection: Camera and shaver must be
switched between posterior and lateral
portal
Portals for Subacromial
Bursectomy
Posterior Portal:

standard posterior portal used for
glenohumeral joint inspection: 2cm distal and
medial to posterolateral border of acromium
Portals for Subacromial Bursectomy
Lateral Portal:

3 fingerbreadths distal from the anterolateral
border of the acromium
Arthroscopic Visualization
Anterior subacromial bursa
Posterior subacromial bursa
Subacromial Decompression
(if necessary)
Cutting Block Technique
Camera in lateral portal
Shaver in posterior portal
Prepare Tear for Repair
Identify type of rotator cuff tear
Mobilize tear through soft tissue releases
Mobilize tear through marginal
convergence sutures
Identify Rotator Cuff Tear
U-shaped tear
Crescentic-shaped repair
L-shaped tear
Mobilize Tear through Soft Tissue
Releases
Resect soft tissue above and below tear
Release of coracohumeral ligament at
base of coracoid
Release of infraspinatus/supraspinatus
interval in line with scapular spine
Mobilize Rotator Cuff through
Marginal Convergence Sutures
Appropriate for U-shaped tear
Principle is to do a side to side tendon
repair in an anterior to posterior direction
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Lateralize the tendon towards the greater
tuberosity
Take tension off the repair to the greater
tuberosity
Mobilize Rotator Cuff through
Marginal Convergence Sutures
Mobilize Rotator Cuff through
Marginal Convergence Sutures
Portals for Suture Technique
Portal location is about periphery of
acromium
Dependent upon the location of the tear
and the type of suture retrieval device
being used.
Technique of Suture Anchor
Placement
Ideal angle of suture anchor is 45° relative
to the long axis of the humerus.
Placement of suture anchor is as close to
greater tuberosity as possible.

Should not repair the tendon under too much
pressure, therefore, a medialized location
may be necessary.
Technique of Suture Anchor
Placement
Sometimes, the medial and lateral
attachments of the rotator cuff are both
repaired (double-row repair)
Portals for Suture Anchor
Placement
Portal placement is verified with a spinal
needle
The needle is directed at 45° to the
humerus and close to the tendon tear
where the repair is necessary
Portals for Suture Anchor
Placement
The site of portal location varies about the
rim of the anterolateral aspect of the
acromium.
Secure Knot Tying
Sliding or half hitch knots
Knot Security
Loop Security
Example of Arthroscopic Rotator
Cuff Repair