Name:
Latero-Lateral Sutures in Arthroscopic Management of Massive Rotator Cuff Tears Surgical Rationale
Description:
Latero-Lateral Sutures in Arthroscopic Management of Massive Rotator Cuff Tears Surgical Rationale
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Duration:
T00H11M24S
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https://cadmoreoriginalmedia.blob.core.windows.net/f18c10a8-42e5-41ff-ae2e-61588a6a44ab/LATERO-LATERAL SUTURES IN ARTHROSCOPIC MANAGEMENT OF MASSIVE.mp4?sv=2019-02-02&sr=c&sig=PMSRrbizJwAFeBno604aoVtP8TPS%2Fftv0NHeRP9yH9s%3D&st=2024-11-21T17%3A33%3A54Z&se=2024-11-21T19%3A38%3A54Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends. I'm Dr. Sergio Rowinski, from SHOULDERPLANET, here from São Paulo, Brazil. And in this nice video, I'm showing you the idea of using latero-lateral sutures, the margin conversion technique, in order to deal with massive lesions of the rotator cuff. This is an outstanding technique that can be very useful, and this is what this video is about.
So I hope you like the video. Please don't forget. Subscribe leave your comment. Give us your thumbs up and let us see this wonderful video. Massive rotator cuff tears are the most difficult kind of rotator cuff tears to be treated, and, for many years, open management has been indicated as the best method of treating those lesions.
Anyway, arthroscopy has been evolving a lot in the recent years, and nowadays even massive rotator cuff tears can be well treated arthroscopically. So this case is about a 68-year-old woman, who had a massive rotator cuff tear in her left shoulder, and, in this photo, we can see an MRI coronal view, in which we can see that she had a quite retracted lesion of the supraspinatus and, in this other image, we can see an MRI, in T2, lateral view, in which we can see that she had a massive tear of both supra and infraspinatus.
So this is her arthroscopy, this is a the left shoulder, we are establishing the anterior portal, using a spinal needle, and opening the capsule with a mosquito. Now we are performing a very fast synovectomy underneath the long head of the biceps, and then the biceps was tested, and, as we pulled the biceps out of the pulley, we could see that the biceps had a lot of fraying and synovitis,
and since the patient was very symptomatic, we decided to perform a biceps tenodesis. So now we are just cleaning the rotator interval and with a spinal needle, we passed a prolene number 2 suture through the long head of the biceps. And now, with a suture grasper, we are just pulling it out of the shoulder through the anterior portal. And since then, with the biceps whipstitch done,
we just had to perform a simple and fast biceps tenotomy. So now the biceps tenotomy has been finished, and then we would just have to perform a very fast debridement of the biceps anchor, and then we would have to go to the subacromial space. So now we are working through the lateral portal, removing all the synovitis underneath the acromion, and when the bursitis was removed, we started to see the tendon, and now we are just seeing the tendon, and cleaning the bursal leaders in the posterior part of the tendon,
we can see that the patient had a very big lesion, as we had already seen on MRI, and now we changed the portals. So we are watching through the lateral portal and, through the posterior portal, we're cleaning the bursal leaders in the anterior part of the tendon, and we can clearly see the biceps whipstitch. Now we are cleaning the posterior bursal leaders, at that moment, we decided that we would be able to fix the lesions, so we changed the portals to perform a simple acromioplasty.
So now working through the lateral portal, we are releasing the coraco-acromial ligament, and once coracoacromial ligament was released, we would just have to perform a very fast and simple acromioplasty. So working through the lateral portal, we are performing a standard acromioplasty, and once the acromioplasty was finished, we would have just to look at the tendon, and now we are starting to clean the tendon, using a simple grasper, working through the lateral portal, and we are removing the tips of the tendon because we know that they are quite devascularized.
And now we are cleaning the anterior part of the tendon, too, and now the posterior part of the tendon, and once the tendon was totally cleaned, we started to create a bony bed, in the greater tuberosity, working with the soft tissue shaver, and now we are just cleaning the greater tuberosity, to create a bone bed, and once a bony bed was created, we used a spinal needle to put the first anchor, in the very anterior part of the greater tuberosity.
So now we unloaded the first anchor, because, only with one suture, we thought we would be able to perform the biceps tenodesis. So now, using a simple suture passer, we passed a prolene number 2 suture through the long head of the biceps, and now we are pulling this prolene out of the shoulder, through the lateral portal, and in a retrograde fashion, we passed the first part of the blue suture through the long head of the biceps.
So now the suture is being passed, and we would just have to repeat the procedure again, so now both parts of the blue suture were passed through the long head of the biceps, and at that moment, we would just have to tie a simple knot to perform a biceps intra articular tenodesis. So now the knot is being done, and once the knot was done, we would just have to cut.
And at that moment, the biceps tenodesis was done. So then we changed the portals again, now we are watching through the lateral portal, that was really a massive lesion, so we started to release the lesion from all adhesions of the glenoid. And the first thing we decided to do was to perform a lateral knot, passing through the medial part of the posterior tendon. So we passed a birdbeak, passing the white suture that was removed from the first anchor, and, in the same way, we passed that birdbeak, through the anterior part of the tendon, and in a retrograde fashion, we pulled that white suture out of the anterior portal.
So then we would have to pick the two parts of the suture, the anterior one, and then the posterior part of the white suture, and pull both of them out of the portal, and then the lateral knot would have to be done. So now we are tying the knot, a simple sliding Duncan knot, now the knot has been tied, and once the knot was tied, it would just have to be cut.
Now the knot is being cut, and at that moment, with a single lateral knot, we understood that the tendon was in a much better condition, so then we changed the portals, again, and now watching through the posterior portal and working through the lateral portal, we put a second anchor, in the very posterior part of the greater tuberosity. So now we are putting another 5.0 absorbable double loaded anchor.
And once the anchor was in a good position and firm, we used the EXPRESSEW device and passed the white suture through the very posterior part of the infraspinatus. So now we are passing the white suture through the posterior part of the infraspinatus, and just pulling it out of the shoulder with a simple suture grasper. So then the knot would have to be tied. Now we are tying the knot, putting a lot of compression under the tendon.
And once the knot was done, we would have just to cut it, and then, working through the anterolateral portal, we repeated the procedure, using the EXPRESSEW again, passing the blue suture of the second anchor through the transition of the infraspinatus with the supraspinatus. So, in the same way, we would have just to pull that suture out of the shoulder with a suture grasper,
and then, again, tie another knot. So another knot is being tied. And once the knot was tied, we would just have to cut it. So now the knot was cut, and at that moment we changed the portals, and now, through the lateral portal, we could understand that the anterior part of the tendon would still have to be fixed, so we cleaned the very anterior part of the greater tuberosity, and, at that moment, we put a third anchor, in the very anterior part of the greater tuberosity, just behind the biceps tenodesis.
And then we passed the suture, the blue suture again, and we would have just to pull that suture out of the shoulder in the same way, with a suture grasper, and then the knot would have to be tied, so, with a cannula through the lateral portal, we tied that knot. Now the not is beeing tied. And once the knot was tied, it would have to be cut.
So now the knot is being cut, and at that moment the surgery was finished. This is the final construct, we are viewing through the lateral portal, so this is the supraspinatus, and we are seeing, now, the infraspinatus, and now we are seeing the biceps tenodesis, in the anterior part of the humeral head, we can see that a very strong construction was done. And now, as we internally and externally rotate the shoulder, we can see a very strong fixation of the infraspiantus, now with a white stitch, in the very posterior part,
and now we are seeing the blue stitch, of the infra and supraspinatus, and another blue stitch, of the supraspinatus, and, as we externally rotate the shoulder, we can see, again, the articular biceps tenodesis. So, my friends, I hope you liked the video, please don't forget. Leave your comment, give us your thumbs up.
Subscribe, show it to your friends, and see you in the next video, as Dr. Sergio always says. Never stop flying. See you, my good friends.
