Name:
Rotator Cuff Trans-tendon Arthroscopic Repair
Description:
Rotator Cuff Trans-tendon Arthroscopic Repair
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/396f2c98-8b75-4134-bc06-336c32240534/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H10M48S
Embed URL:
https://stream.cadmore.media/player/396f2c98-8b75-4134-bc06-336c32240534
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/396f2c98-8b75-4134-bc06-336c32240534/ROTATOR CUFF TRANS-TENDON ARTHROSCOPIC REPAIR.mp4?sv=2019-02-02&sr=c&sig=zJeG4TUQkE%2BD4PWI65wm%2FJKMEZaf8tufu%2B0h63z2Xxc%3D&st=2024-11-23T16%3A17%3A48Z&se=2024-11-23T18%3A22%3A48Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski from shoulder planet here, from Sao Paulo, Brazil. And, in this video, I'm showing you, guys .in a very interesting way of managing a small partial tear of the supraspinatus with a trans-tendon repair. Whenever you find, whenever we find a small tear of the supraspinatus, an articular tear of the anterior insertion of the supraspinatus, there are many things that we can do to manage the situation.
We can debride, the tear. When that is an indication, we can complete the tear and fix it. Sometimes we can do a reinforcement, and, in some times, we can even do a tranns-tendon repair, and this is what this video is about. This is a technique that I have done a few times in my life. I find it a little bit hard working, in spite of being very beautiful and very efficient.
Nevertheless, it's interesting for the orthopedic surgeon, or any shoulder guy, to know how to do it, and to know about the existence and the steps of such technique. So I hope you like the video. Please don't forget. Subscribe we need our subscription in the channel. Give us your thumbs up. Leave your comments, and let's see the video.
So this case is about 32-year-old man, a 32-year-old patient, who started to have pain over his right shoulder about seven months ago. And he's a very strong man, who has always gone to the gym, and he's a very active surfer. And when he came to the office,after taking his history and physical examination, it was, very evident that he had very clear signs of an AC joint degenerative situation, that was very strongly confirmed by his MRI.
We tried conservative management for about two months, with physical therapy and even an injection in his subacromial space, and in the AC joint. He had a very nice result and he came back to surfing. But, after one month, all his symptoms were coming back, and at that time we decided to perform an arthroscopic surgery. So this is his MRI, an AP VIEW, in which we can see very clear signs of an AC joint degenerative situation, like edema, very intense edema, in the AC joint.
And now we are seeing another image, in which we can see in an axillary view, a lot of edema and a huge cyst in the very distal part of his right clavicle. So this is his arthroscopy. Now we are seeing the joint. We are in the articular surface. Now we have seen the subscap layers, that was really in a nice condition, and now we are seing the biceps pulley, very nice.
And when we took a look in the postero-superior part of the articular cuff, we could see that he had quite a pasta lesion, that was definitely not shown in the standard MRI. So then we performed the anterior portal in a very standard fashion, and we performed a very slight debridement of the anterior labrum, beut that was definitely not the place of his pathology.
And now we are showing the anchor of the biceps just to show that he had no SLAP lesion, and then we tested the biceps itself. That was really in a nice condition, and pthe pulley was really looking nice. So before going to the subacromial space, we marked the lesion, using a prolene, and we would just have to pull that
prolene through the anterior portal, then we went to the sub acromial space, with a lot of bursal tissue, a lot of synovitis, and we have to remove all that, and then we finally saw our prolene. And that particular patient had a very intense inflammatory tissue above the postero-superior cuff. We had to remove all that inflammatory tissue.
And,after that, we started to palpate the tendon, the tendon was really looking good, and we decided, at that moment, to perform a trans tendon suture, because this patient is very young, and very strong, and very, very, very active. So now we are inside the joint again, and marking the place in which we are going to put our anchor, using an 11 blade,very slightly, very slowly.
We created an opening in the tendon. And through that small opening, we passed just one anchor, a 5.0 metallic anchor. Then we put the anchor, and after the anchor was in place, we passed all the sutures to the articular side, using a kelly, a simple hemostate. Throug the anterior portal
we would have to pull one of those sutures, first the green one, and the white one, and, at that moment, using a spinal needle, we passed a prolene, passing through the tendon. We passed that prolene through the anterior portal, through the anterior portal, when we just pulled that back to the anterior, to the subacromial space again.
First, the blue one, and now we would have to do the same stuff, to pass the white one through tendon and coming back to this subacromial space. So once we passed both sutures we came back to the subacromial space. At that moment, we could see all four sutures and we would have to tie them. First
the white one. And we used a very simple sliding Duncan stitch. Once the speech was done, we would have to do the same thing with the another one. This is what we are doing now.
And then we would have to tie the knot again. And after that, we would just have to cut it. And this is the now the final, the final view of our fixation, in which we can see that pasta lesion was very strongly fixated. So at that moment, we would just have to perform the Mumford surgery. I always start the MUMFORD surgery working through the anterior or the posterior portal, and watching always for the lateral view.
Now we are working through the anterior portal and removing the inferior AC capsule. Once the AC inferior capsule was removed we started to remove the very inferior parts of the distal clavicle using the osseous shaver. And at that moment, I always like to pass a kirschner wire and that kirschner wire is going to guide my arthroscope, to enter in the very posterior part of the AC joint.
Now we are seeing the clavicle on the left, the acromion on the right, now we are under the subacromial space, and we can see there is some bone left in the very anterior distal part of the clavicle. We would have to remove it, until we see the superior AC ligament. And now we're starting to see the superior AC ligament. And I always like to remove all the capsule from the medial parts of the acromion.
Now we are starting to remove the medial parts of the capsule, until we see all the bony side of the medial acromion, and this is it and, at that time, I like to switch the portals again now we are seeing through the anterior view, and there is some bone left in the very posterior part of the clavicle.
And this is the final view, the clavicle on the right side, the acromion on the left side, a nice space was then created, and then we just checked the posterior view again. Now we are seeing the clavicle on the left, the acromion on the right side, and the superior ligament in the middle of them, and a very safe zone was created and at that moment the surgery was finished. So my friends, I hope you liked this nice video, about the trans tendon repair of a small partial tear of the supraspinatus.
So don't forget to subscribe. Thumbs up! Leave your comment. See you in the next video, and Dr Sergio always says, never stop flying. See you, folks.
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