Name:
Lower Trapezius Transfer for Massive Cuff Tear
Description:
Lower Trapezius Transfer for Massive Cuff Tear
Thumbnail URL:
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Duration:
T00H05M59S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/8e89ff8a-b312-4d1f-95ca-d660804026cc/Lower trapezius transfer for massive cuff tear.mp4?sv=2019-02-02&sr=c&sig=fk9qpcdruZabdlWFD8qmSvqCeYQMlwbNBOj%2BIYXDaPM%3D&st=2024-11-21T16%3A10%3A31Z&se=2024-11-21T18%3A15%3A31Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Arthroscopic assisted lower trapezius transfer for massive posterior superior rotator cuff tears. Place the patient in the standard lateral decubitis arthroscopy position, but make sure that the drape comes down to the midline to give full exposure to the medial border of the scapula. We routinely soak the graft in vancomycin, and this is done at the start of the procedure. Make a 5 centimeter incision along the lower border of the scapular spine and identify the lower trapezius, which inserts about 3 centimeters from the medial border.
Release the tendon from the scapular spine and mobilize it until it moves freely. If there is bone attached to the allograft, remove this and place a whip stitch along the terminal two centimeters of the graft and then two separate stitches at the two centimeter mark. Using different color stitches will help identify them arthroscopically. It is a good idea at this stage to label the top surface of the graft and the medial and lateral sides so that you can check that there are no twists later on.
Introduce the arthro scope into the bursa and debride any scar tissue or old sutures down to a good bleeding base in the greater tuberosity. Use a Roberts to create the passage under the deltoid into the subacromial bursa and use this to introduce the graft via the whip stitch sutures. Hand the whip stitch sutures off through an anterior portal.
Introduce the graft into the bursa and check that it is not twisted by confirming with the marks that you made previously. Withdraw the graft slightly to give a clear view of the greater tuberosity again. Pilot holes are now made for the anchors at the posterior lateral and posterior medial aspect of the greater tuberosity and one at the front of the greater tuberosity in the region of the bicep little groove.
Reintroduce the graft and remove the lateral sutures through the lateral portal and the medial sutures through the medial portal, along with the anterior sutures through the anterior portal. At the end of this, the sutures should look like the picture.
The anterior whip stitch sutures can now be secured using a swivelock anchor. The medial posterior suture can now be secured with a swivelock anchor
in the previously made pilot hole. In this case, the sutures are not cut, but are retained to repair the remnant rotator cuff later. The lateral row is then secured in a similar manner and on this side, the sutures can be cut.
The medial row sutures are then used to repair the rotator cuff remnant, bringing it up towards the greater tuberosity. These are secured using an additional swivelock anchor placed laterally.
Excess graft is then removed and the graft is split longitudinally. A whip stitch is passed along the lateral side of the now split graft for a length of about 2 centimeters. A split is made in the lower trapezius tendon and the sutures are passed from the under surface to the top surface to pull the lateral side of the graft through the tendon so that it can be folded back on itself.
Keeping the tension on the graft, it is now sutured to itself and to the lower trapezius tendon along its length and back again. The medial side of the Achilles tendon graft can then be laid over the top of the repair and sutured in place to complete it. Post operatively, the patient is placed in an abduction sling for a period of six weeks before rehabilitation is commenced.
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