Name:
Rotator Cuff Arthroscopic Reinforcement for the Management of Intrasubstance Tears
Description:
Rotator Cuff Arthroscopic Reinforcement for the Management of Intrasubstance Tears
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/f9e4de52-1394-4ac5-aafe-3492f0b40e7d/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H08M25S
Embed URL:
https://stream.cadmore.media/player/f9e4de52-1394-4ac5-aafe-3492f0b40e7d
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f9e4de52-1394-4ac5-aafe-3492f0b40e7d/Logo - ROTATOR CUFF ARTHROSCOPIC REINFORCEMENT FOR THE MANAG.mp4?sv=2019-02-02&sr=c&sig=%2FWfQGEORO%2FJmVGu3L2M76GvOGIozw%2FjPKibJKggK6MI%3D&st=2024-11-21T16%3A58%3A26Z&se=2024-11-21T19%3A03%3A26Z&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. In this video, I'm showing you guys a very interesting way of dealing with partial rotator cuff tears, which need surgery with a technique which is named the rotator cuff re-inforcement.
Many times we have partial tears of the supraspinatus which need surgery, which did not respond to conservative management. But in spite of the surgical indication and in spite of the tear being very clear, I mean the partial tear in the MRI when we enter with the arthroscope we feel it's a little bit painful to complete the tear and then to fix it.
So there is another option, which is to reinforce just to make a reinforcement to independent, which can be done with an anchor or even without an anchor. In this case, I am showing it to you with an anchor. So please subscribe to the channel. Give us your thumbs up or leave your comment and let's see the video. With the development of arthroscopy and with the improvements in MRI, shoulder surgeons nowadays know that there are many types of rotator cuff lesions, and when we consider partial lesions, we can have three different situations articular lesions.
The so-called pasta lesions, Bertha lesions and interstitial lesions too. Interstitial lesions are the less common type of partial rotator cuff tears. And this is what this case is about. So this case is about a 50-year-old truck driver, a very hard worker who started to have pain over his right shoulder about six months ago. His MRI revealed an interstitial supraspinatus lesion, and he had also a very painful, achy degenerative arthritis, too.
So we tried conservative management with an injection both in his subacromial space and in his AC joint with physical therapy for about four months with absolutely no results. And then finally, an arthroscopy was indicated to evaluate and probably fix his rotator cuff partial tear and to perform among four procedure too. So this is his arthroscopy.
Now we are seeing a right shoulder, reestablishing the anterior portal, using a spinal needle and then opening the capsule with a hemostatic mosquito. Now we are palpate in the biceps and this is not a slab, just that there's an active condition and his biceps. When we probed it, it was in a very nice state, too. So then when we looked in the articular part of the lesion, we saw the lesion and then we decided to mark it with proline person for a spinal needle.
And after that, we went to the subacromial space. So now we are working for the lateral portal, watching for the posterior portal to removing all the bursitis and the sinovitis until we found the acromion. Now we are cleaning the lateral gutter, which in my opinion, is a very important step to see this subacromial space. Now we have seen the antero lateral aspect of the acromion and for the lateral portal, we are performing a very slight and simple acromioplasty.
Now the acromioplasty is finished and then we move the protal or we are watching for the lateral portal. This is the acromion and now with the spinal needle reestablishing and enter a superolateral portal. Now, for the antero superlateral portal, we are cleaning the tip of the acromion just to see the acromioplasty that was fine. And then we start to look at the tendon.
So now we are looking at the posterior superior curve. Now we have seen our proline to mark the lesion. Then we started to ablate the superior fibers and to top it with the ablater the posterior superior girth. And that moment we decided that there was no reason to complete that lesion. But since that patient was very symptomatic, we decided to perform a rotator cuff reinforcement. So now we have seen the greater tuberosity we are preparing a very small bony bed just to one anchor.
Now we are putting the hole. We are. We are using the anchor guide and now we are introducing a 5.0 absorbable, double loaded anchor. And once the anchor was in place using for the anterior portal using a simple BirdBeak, we tested the first suture the White one in a retrograde fashion for the anterior part of the posterior superior curve.
This is what we are doing now. And then we performed the first knot, a sliding danker knot. Now we are putting a lot of compression, as we can see on the video. And once the knot was tied, we just have to cut it and then through the posterior portal in a retrograde fashion too. we passed another BirdBeak for the supraspinatus and parts of the second suture in the retrograde fashion, too.
Then the knot was done. And this is the final construct in which we can see that a very strong reinforcement was performed in the posterior superior cuff. So then we would have to perform the mm4 procedure now we.
