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Name:
Basic Steps to do a Rotator Cuff Double-Row Repair
Description:
Basic Steps to do a Rotator Cuff Double-Row Repair
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T00H12M45S
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https://cadmoreoriginalmedia.blob.core.windows.net/a71aef0a-4544-41c6-9e6d-31849a16a1fd/BASIC STEPS TO DO A ROTATOR CUFF DOUBLE-ROW REPAIR.mp4?sv=2019-02-02&sr=c&sig=OZmuBbh%2BmFl4aX16XyKOEYBlZ31obLZaSHl21Ihk14o%3D&st=2024-11-22T04%3A54%3A43Z&se=2024-11-22T06%3A59%3A43Z&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 São Paulo, Brazil. And in this video, I'm presenting to you a nice way of doing a double row technique in a small supraspinatus cuff lesion. It's important for us to understand that, besides single row or double row, many things are important in a rotator cuff repair,
in order for us to achieve a good result. That includes, of course, a tension free repair and adequate post-operative rehabilitation. Nevertheless, it's important for any shoulder surgeon to know how to do a double row, and this is what this video is about. So I hope you like it, give us your thumbs up, your like, leave your comment, and I hope you like the video.
Supraspinatus PASTA lesions are common problems in every shoulder surgeon's office, and their management depends, including other factors, on the thickness of the tear. The term PASTA means Partial Articular Supraspinatus Tendon lesion, or tendon avulsion. Usually, if the tear has less than 50% of the tendon thickness, conservative management is indicated.
And, in the other hand, if the tear involves more than 50% of the tendon thickness, surgery is usually a tendency. These lesions occur, generally, in younger patients, and they really ache a lot. So here I'm presenting a case, from a 47-year-old man, who does not play sports, and who started to have a very typical subacromial symptoms, in his left shoulder, in July 2011.
Here we see his MRI, revealing a very typical anterior supraspinatus PASTA lesion, in which we can see that the tear involves more than 50% of the tendon thickness. I told him, at that moment, in the beginning of the treatment, that we would try conservative management, initially, before going directly to surgery. So, we performed, in October 2011. a subacromial injection in his left shoulder.
The patient really did evolve very well, with absolutely no pain in his left shoulder, and two weeks after that injection, we started some strengthening rotator cuff exercise, in his home, and he started some physical therapy, too. So the patient did very well for about three months, but, in February 2012, in the beginning of this year, his pain was back again. So I suggested him about surgery,
but the patient strongly insisted to receive a second injection, a second shot. So we did it, in February 2012, and the patient did, again, very nice, and he stayed pain free for about a month. But then, in March this year, the pain came back again, and after that an arthroscopy was indicated, and the patient was operated in July 2012.
So this is his arthroscopy, here we see a left shoulder, we are seeing the biceps, and the biceps anchor, the biceps was quite ugly, so we decided to perform a biceps tenotomy and maybe a tenodesis, But first we would have to perform a whip stitch. So now we are doing the whip stitch, in a very classical fashion, and passing a prolene through the biceps and pulling it out of the shoulder through the anterior portal.
Then, with an arthroscopic scissor, we started the biceps tenotomy, that was done in a very fast manner, and it's a very simple procedure. We ended the biceps tenotomy with a simple, soft tissue shaver. And now we can see that the biceps is tenotomized and stuck in the biceps pulley. So we took a very fast analysis of the subscap, that was pretty OK,
and then we saw the PASTA lesion. So here we can see the PASTA lesion, very typical, and then we entered with a shaver, through the articular part of the shoulder, we tried to complete the tear, it was very hard because we didn't have much space, so then we immediately moved to the subacromial space. We have to perform a formal bursectomy, small tears like this always have a huge bursa, so we would have to debride all that bursal tissue until we started to find the inferior surface of the acromion.
Now we can see the inferior surface of the acromion, with very typical arthroscopic findings of impingement, with fraying, and here we can see the lateral gutter and the antero lateral gutter, also. So we used a shaver, to clear the lateral gutter, and here we have to find the anteroateral corner of the acromion, to know where we are, until we see the deltoid.
Now we can see the antero-lateral corner, and we so continued with the shaver, to create a space, to create a view, and to clean the lateral gutter, as we are seeing, here. So at that moment, we changed the portals, and now working with the shaver through the posterior portal, we continued to clean the anterior gutter. It's very important to say that, in these cases, with very small anterior tears,
we have to clean the lateral and the anterior gutters very well, and this is what we are doing now. So after that, we saw the tear, here we can see a very small tear with the biceps inside it, a very anterior tear, and then, using a spinal needle, we established an anterosuperolateral portal, that we would use to manipulate the lesion, and to pass the anchors.
So we entered with the soft tissue shaver, we started to debride all the pathologic tissue, and we started to complete the tear, and that can be done with the soft tissue shaver, and with electrocautery, as we are doing here, not only to create space, but also to prepare a bony bed in the greater tuberosity, in which we would fix the tendon. So then we changed the portals again, and now we are working through the posterior portal, to perform a very simple and fast acromioplasty,
this is a procedure that shall not take more than three or five minutes, and this is what we are doing now, and here we can see that the acromioplasty is finished. And then we changed the portals again, now the camera is in the lateral portal, and through the posterior portal, we are just ablating the superior fibers of the tendon, and now, through for the antero-supero-lateral portal, we are putting the first anchor, the medial one, since we wanted to perform a double row suture repair.
Once the anchor was put, this is a 5.0 double loaded metallic anchor, we entered with a grasper, through the antero-supero-ateral portal, we grasped a healthy bite, but very gently, of the tear, of the tendon, and through the posterior portal, we entered with a spectrum device, and we passed a Prolene suture, that was just put out of the shoulder with a simple grasper, through the antero-supero0lateral portal,
and, then, in a retrograde fashion, we would pass the posterior leg of the medial row suture, and then we unloaded the white one, ince we just wanted one suture in the medial anchor, and we would have to pass another prolene, but now through the anterior portal, and this is what we are doing now. So the prolene was grasped again, and put out of the shoulder, through the antero-supero-lateral portal.
And, then, in a retrograde fashion, the anterior leg of the media row was passed through that tendon. Then we would have to put a second anchor, a more lateral one, to perform the lateral row sutures, but first, through the anterior portal, we isolated the sutures, this is something we think is very important, because we don't want to make a mess with the sutures, and then with the white one isolated, in the anterior portal, that was being used as a waiting portal,
with an EXPRESSEW device, we passed the posterior lateral row suture, and that one was grasped out of the shoulder through the posterior portal. And then we would have to pass both legs of that posterior lateral row suture, out of the anterior superolateral portal, and tie that knots. So now we are tying the posterior lateral roll, not putting a lot of pressure, in order for the tendon to heal in the bony bed that we had just created.
And, once the stitch was done, we would just have to cut it. So then the suture was cut, the knot was cut, and we would have to put both white sutures, through the antero superolateral cannula, and pass, again with an EXPRESSEW device, the anterior lateral row suture. So, now we are passing, with an EXPRESSEW, the anterior lateral suture
and we would have to put that out of the shoulder, now with a grasper through the anterior portal, and, then, pass and tie the second lateral row suture, the anterior one. So, with a suture manipulator, we put both legs of the white one out of the shoulder, when we tied the second knot. So now the lateral row is done, and fixed. So now that the lateral roll was done, we would just have to pick both legs of the medial row suture. First, the posterior, one as we internally rotate the shoulder, and after that, the anterior one, as we externally rotate the shoulder, to tie the medial row knot.
So now we are tying, through the antero superolateralportal, the antero superolateral cannula, the medial row, and once the knot was tied, it would have to be cut. And this is the final image, the final construct, here we can see the lateral row, the medial row, and with a very good re attachment of the footprint. and, as we look upon the subacromial space, we can see here the acromioplasty, that was very nice, and back again, looking down,
you know, we can see the final image. Here we can see the lateral row, and the medial row, and, at that moment, the surgery was then finished, with a very good reconstruction of the footprint. So, my friends, I hope you liked the video, about how to do a nice double row in supraspinatus cuff there. Don't forget, please, to subscribe,
we need our subscription, Live your like, give us your thumbs up. See you in the next video. And as Dr. Sergio always says, never stop flying.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski, from shoulder planet, here from São Paulo, Brazil. And in this video, I'm presenting to you a nice way of doing a double row technique in a small supraspinatus cuff lesion. It's important for us to understand that, besides single row or double row, many things are important in a rotator cuff repair,
in order for us to achieve a good result. That includes, of course, a tension free repair and adequate post-operative rehabilitation. Nevertheless, it's important for any shoulder surgeon to know how to do a double row, and this is what this video is about. So I hope you like it, give us your thumbs up, your like, leave your comment, and I hope you like the video.
Supraspinatus PASTA lesions are common problems in every shoulder surgeon's office, and their management depends, including other factors, on the thickness of the tear. The term PASTA means Partial Articular Supraspinatus Tendon lesion, or tendon avulsion. Usually, if the tear has less than 50% of the tendon thickness, conservative management is indicated.
And, in the other hand, if the tear involves more than 50% of the tendon thickness, surgery is usually a tendency. These lesions occur, generally, in younger patients, and they really ache a lot. So here I'm presenting a case, from a 47-year-old man, who does not play sports, and who started to have a very typical subacromial symptoms, in his left shoulder, in July 2011.
Here we see his MRI, revealing a very typical anterior supraspinatus PASTA lesion, in which we can see that the tear involves more than 50% of the tendon thickness. I told him, at that moment, in the beginning of the treatment, that we would try conservative management, initially, before going directly to surgery. So, we performed, in October 2011. a subacromial injection in his left shoulder.
The patient really did evolve very well, with absolutely no pain in his left shoulder, and two weeks after that injection, we started some strengthening rotator cuff exercise, in his home, and he started some physical therapy, too. So the patient did very well for about three months, but, in February 2012, in the beginning of this year, his pain was back again. So I suggested him about surgery,
but the patient strongly insisted to receive a second injection, a second shot. So we did it, in February 2012, and the patient did, again, very nice, and he stayed pain free for about a month. But then, in March this year, the pain came back again, and after that an arthroscopy was indicated, and the patient was operated in July 2012.
So this is his arthroscopy, here we see a left shoulder, we are seeing the biceps, and the biceps anchor, the biceps was quite ugly, so we decided to perform a biceps tenotomy and maybe a tenodesis, But first we would have to perform a whip stitch. So now we are doing the whip stitch, in a very classical fashion, and passing a prolene through the biceps and pulling it out of the shoulder through the anterior portal.
Then, with an arthroscopic scissor, we started the biceps tenotomy, that was done in a very fast manner, and it's a very simple procedure. We ended the biceps tenotomy with a simple, soft tissue shaver. And now we can see that the biceps is tenotomized and stuck in the biceps pulley. So we took a very fast analysis of the subscap, that was pretty OK,
and then we saw the PASTA lesion. So here we can see the PASTA lesion, very typical, and then we entered with a shaver, through the articular part of the shoulder, we tried to complete the tear, it was very hard because we didn't have much space, so then we immediately moved to the subacromial space. We have to perform a formal bursectomy, small tears like this always have a huge bursa, so we would have to debride all that bursal tissue until we started to find the inferior surface of the acromion.
Now we can see the inferior surface of the acromion, with very typical arthroscopic findings of impingement, with fraying, and here we can see the lateral gutter and the antero lateral gutter, also. So we used a shaver, to clear the lateral gutter, and here we have to find the anteroateral corner of the acromion, to know where we are, until we see the deltoid.
Now we can see the antero-lateral corner, and we so continued with the shaver, to create a space, to create a view, and to clean the lateral gutter, as we are seeing, here. So at that moment, we changed the portals, and now working with the shaver through the posterior portal, we continued to clean the anterior gutter. It's very important to say that, in these cases, with very small anterior tears,
we have to clean the lateral and the anterior gutters very well, and this is what we are doing now. So after that, we saw the tear, here we can see a very small tear with the biceps inside it, a very anterior tear, and then, using a spinal needle, we established an anterosuperolateral portal, that we would use to manipulate the lesion, and to pass the anchors.
So we entered with the soft tissue shaver, we started to debride all the pathologic tissue, and we started to complete the tear, and that can be done with the soft tissue shaver, and with electrocautery, as we are doing here, not only to create space, but also to prepare a bony bed in the greater tuberosity, in which we would fix the tendon. So then we changed the portals again, and now we are working through the posterior portal, to perform a very simple and fast acromioplasty,
this is a procedure that shall not take more than three or five minutes, and this is what we are doing now, and here we can see that the acromioplasty is finished. And then we changed the portals again, now the camera is in the lateral portal, and through the posterior portal, we are just ablating the superior fibers of the tendon, and now, through for the antero-supero-lateral portal, we are putting the first anchor, the medial one, since we wanted to perform a double row suture repair.
Once the anchor was put, this is a 5.0 double loaded metallic anchor, we entered with a grasper, through the antero-supero-ateral portal, we grasped a healthy bite, but very gently, of the tear, of the tendon, and through the posterior portal, we entered with a spectrum device, and we passed a Prolene suture, that was just put out of the shoulder with a simple grasper, through the antero-supero0lateral portal,
and, then, in a retrograde fashion, we would pass the posterior leg of the medial row suture, and then we unloaded the white one, ince we just wanted one suture in the medial anchor, and we would have to pass another prolene, but now through the anterior portal, and this is what we are doing now. So the prolene was grasped again, and put out of the shoulder, through the antero-supero-lateral portal.
And, then, in a retrograde fashion, the anterior leg of the media row was passed through that tendon. Then we would have to put a second anchor, a more lateral one, to perform the lateral row sutures, but first, through the anterior portal, we isolated the sutures, this is something we think is very important, because we don't want to make a mess with the sutures, and then with the white one isolated, in the anterior portal, that was being used as a waiting portal,
with an EXPRESSEW device, we passed the posterior lateral row suture, and that one was grasped out of the shoulder through the posterior portal. And then we would have to pass both legs of that posterior lateral row suture, out of the anterior superolateral portal, and tie that knots. So now we are tying the posterior lateral roll, not putting a lot of pressure, in order for the tendon to heal in the bony bed that we had just created.
And, once the stitch was done, we would just have to cut it. So then the suture was cut, the knot was cut, and we would have to put both white sutures, through the antero superolateral cannula, and pass, again with an EXPRESSEW device, the anterior lateral row suture. So, now we are passing, with an EXPRESSEW, the anterior lateral suture
and we would have to put that out of the shoulder, now with a grasper through the anterior portal, and, then, pass and tie the second lateral row suture, the anterior one. So, with a suture manipulator, we put both legs of the white one out of the shoulder, when we tied the second knot. So now the lateral row is done, and fixed. So now that the lateral roll was done, we would just have to pick both legs of the medial row suture. First, the posterior, one as we internally rotate the shoulder, and after that, the anterior one, as we externally rotate the shoulder, to tie the medial row knot.
So now we are tying, through the antero superolateralportal, the antero superolateral cannula, the medial row, and once the knot was tied, it would have to be cut. And this is the final image, the final construct, here we can see the lateral row, the medial row, and with a very good re attachment of the footprint. and, as we look upon the subacromial space, we can see here the acromioplasty, that was very nice, and back again, looking down,
you know, we can see the final image. Here we can see the lateral row, and the medial row, and, at that moment, the surgery was then finished, with a very good reconstruction of the footprint. So, my friends, I hope you liked the video, about how to do a nice double row in supraspinatus cuff there. Don't forget, please, to subscribe,
we need our subscription, Live your like, give us your thumbs up. See you in the next video. And as Dr. Sergio always says, never stop flying.
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