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1. Emmanuel Antonogiannakis
Director,
2nd
Orthopaedic Department,
Athens Army Hospital
Arthroscopic Rotator Cuff Repair

2. Rotator cuff disease is a spectrum
of clinical conditions, which range from
asymptomatic partial thickness tears to
symptomatic rotator cuff arthropathy

3. Successful RC Repair
Codman EA. Rupture of the supraspinatus
tendon Boston Medical & Surgical Journal
1911 Vol clxiv (2) 708-10
McLaughlin HL. Lesions of the musculotendinous
cuff of the shoulder: the exposure and repair of
tears with retraction. J Bone Joint Surg 1944;26:31-51.
First Description of RC tears
Smith JG. London. Med Gaz, 1834,14:280
Pathological appearances of seven cases
of injury of the shoulder joint, with remarks.
EA Codman
HL McLaughlin

4. The Gist of Operative Treatment
 Stable RC repair
 Restoration of tensile strength
 Creation of an environment that facilitates
healing mediated by the bursa
 Prevention of bone/tendon gap formation
Example of applied basic science in surgery

5. ANY TYPE OF RECONSTRUCTION
MUST AVOID TENSION OVER-LOAD
OF THE REPAIR

6. Stable fulcrum(SS-part IS) Unstable fulcrum(SS-IS)

7. Full vs Partial Thickness Rotator Cuff
Tears

8. Partial RC tear
Joint side vs bursal side tears

9. COMPLETE TEARS
• Small 1cm
• Medium 2-3cm
• Large 3-5 cm
• Massive >5cm

10. Surgical Technique
1. GH Joint and Subacromial Joint Inspection
2. Bursal debridement
3. Acromioplasty
4. Cuff mobilization
5. Repair (side to side, tendon to bone)

11. Patient position
Lateral decubitus
Traction3-4 kgr
Abduction 20 degrees

12. Portals
Outside in technique

13. Portal creation

14. Bleeding control

15. Bleeding control

16. Bleeding control

17. Cuff Inspection, Partial Tear

18. Cuff Inspection, Complete Tear

19. Crescent Shaped Tear

20. Closing an L-shaped or U-shaped tear is much like closing a tent flap
Closure of an U-shaped tear involves first side-to-side closure
of the vertical limb of the tear, then tendon-to-bone closure of the
transverse limb
L or U -shaped tear

21.  Large U-shaped cuff tear
extending to glenoid
 Margin convergence
 The free margin of the cuff is
repaired to bone with suture
Cuff mobilization

22. Margin convergence
Balancing of Force Couples
(shift posterior leaf of cuff)

23.  Large U-shaped cuff tear
extending to glenoid
 Margin convergence
 The free margin of the cuff is
repaired to bone with suture
anchors

24. Single and double interval slide
• Anterior slide through release in the rotator
interval (supraspinatus–coracobrachialis)
• Posterior slide through release of the
interval supraspinatus-infraspinatus

25. Side to Side Repair
Cuff repair

26. Side to Side Repair

27. Cuff repair
Tendon to bone repair

28. Double Row Fixation
Restoration of the footprint

29. Double Row Fixation

30. Double Row Fixation

31. Double Row Fixation

32. Subscapularis Repair
Recognition

33. Subscapularis Repair

34. Long head of bicepts tenodesis

35. Arthroscopic repairs do not heal faster
Knowledge of biomechanical principles is
mandatory in choosing repair type
Cuff repair is feasible but technically demanding

36. Indications of arthroscopic cuff
repair
• Every repairable cuff tear can be repaired
arthroscopic or a cuff that can be repaired open
can be repaired and arthroscopic
• The decision to repair a cuff tear open or
arhtroscopic depends in the expertise of the
surgeon
• In the long run there is no discernible difference
between mini-open and arthroscopic cuff repairs

37. Arthroscopic cuff repair
Wolf, Snyder, Gartsman, Esch,
Burkhart, Tauro and others reported
84%-94% excelent and good results

38. • Bennett WF. Arthroscopic repair of massive rotator cuff tears: a
prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003
• Boileau P., Brassart N., Watkinson D.J., Carles M., Hatzidakis A.M.,
Krishnan S.G. Arthroscopic repair of full-thickness tears of the
supraspinatus: does the tendon really heal? J Bone Joint Surg Am.
2005
• Buess E., Steuber K.U., Waibl B. Open versus arthroscopic rotator
cuff repair: a comparative view of 96 cases. Arthroscopy. 2005
• Gartsman G.M., Khan M., Hammerman S.M. Arthroscopic repair of
full-thickness tears of the rotator cuff. J Bone Joint Surg. 1998
• Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopic rotator
cuff repair in patients older than 60 years. Arthroscopy. 2005
• Tauro JC. Arthroscopic rotator cuff repair: analysis of technique and
results at 2- and 3-year follow-up. Arthroscopy 1998
• Warner JJ, Tetreault P, Lehtinen J, Zurakowski D. Arthroscopic
versus mini-open rotator cuff repair: a cohort comparison study.
Arthroscopy. 2005
Results of atrhroscopic rc repair

39. Advantages of Arthroscopic Cuff Repair
• Atraumatic
• Deltoid sparing
• Tissue mobilization
• Cosmetic incisions
• Secure repair
• Address accompanying pathology
• No iatrogenic injury to healthy tissues
• Cost-effective on an outpatient basis

40. Disadvantages of Arthroscopic Cuff Repair
• Technically demanding
• Equipment dependent
• Steep learning curve
Know when to keep dealing
or when to pack the cards
in and go home