Rotator cuff repair
PREOPERATIVE DIAGNOSIS
Left rotator cuff repair.
POSTOPERATIVE DIAGNOSIS
Left rotator cuff repair.
PROCEDURE
Left revision rotator cuff repair.
Left extensive debridement arthroscopic.
ANESTHESIA
General with scalene block.
INDICATION FOR PROCEDURE
This patient is an elderly female, that had previously had rotator cuff repair. She developed a tear next to the suturing of her prior rotator cuff repair. She had pain, inability to progress with rehab. She had failed conservative treatment. Because of this, decision was made to proceed forward with operative treatment.
DESCRIPTION OF PROCEDURE
The patient was met in preoperative area. Operative extremity identified and marked. Informed consent discussed and signed including the risks of not limited to, pain, infection, bleeding, weakness, stiffness, numbness, tingling, re-tear, need for further surgery, loss of limb or life. The patient was aware of this and consented for the procedure. The patient was taken to the operative theater, general anesthesia was given. The patient was sterilely prepped and anesthetized in beach chair position. Time-out performed with all personnel. First, a standard posterior and anterior arthroscopic portals were established. There was significant synovitic tissue on the anterior compartment, posterior compartment, as well on the superior labrum. Next, the shaver was introduced. A debridement was performed off the anterior labrum, superior labrum, as well as the anterior compartment at the vicinity of the interval tissue. Subscapularis was found to be intact. The posterior compartment was debrided as well. The posterior labrum was debrided. There was very small amount of loose cartilage, but no exposed bone, this was debrided. The undersurface of the rotator cuff tear was debrided with the motorized shaver. This area was then marked with a PDS suture. After this was done, the medial aspect of the footprint was decorticated, the tear was recessed off the medial footprint approximately 8 mm and this extends for approximately 15-20 mm from anterior to posterior starting just behind the bicipital groove. This was decorticated with the motorized shaver. Next a series of two Arthrex 3.9 corkscrew percutaneous anchors were seated on the medial aspect of the footprint at the anterior and posterior most aspects. Through a separate fascial incision, the subacromial space was entered. There was substantial adhesions in the subacromial space. These were cleared out debriding the bursa, adhesions in the anterior posterior aspect over the rotator cuff. The area of the rotator cuff tearing was probed, there was not found to be full thickness tearing. Thus, the decision was made to proceed forward with a partial repair. The CA ligament was thinned anteriorly and the undersurface of the acromion was cleaned off. There is no subacromial compression visible. Next, we entered back into the joint. A series of two 3.9 Arthrex suture tack knotless anchors were seated at the anterior and posterior aspects of the medial footprint. The repair suture was shuttled into the anchor of the opposite anchor creating a two stranded medial row bridge. This was used intra-articularly to ensure compression of the rotator cuff. After this was tightened adequately, these two repair stitches were placed into one lateral row 4.75 SwiveLock anchor with good tension creating a double row percutaneous partial repair. After this was done, final images were taken intra-articularly was examined and found to be intact and compressed against the medial aspect of the footprint. Next, instruments were removed. The portal sites were closed with interrupted 3-0 Monocryl and Steri-Strips, placed into a dry sterile dressing and sling immobilizer. At the end of the procedure, all sponge, needle, and instrument counts were correct.
Left rotator cuff repair.
POSTOPERATIVE DIAGNOSIS
Left rotator cuff repair.
PROCEDURE
Left revision rotator cuff repair.
Left extensive debridement arthroscopic.
ANESTHESIA
General with scalene block.
INDICATION FOR PROCEDURE
This patient is an elderly female, that had previously had rotator cuff repair. She developed a tear next to the suturing of her prior rotator cuff repair. She had pain, inability to progress with rehab. She had failed conservative treatment. Because of this, decision was made to proceed forward with operative treatment.
DESCRIPTION OF PROCEDURE
The patient was met in preoperative area. Operative extremity identified and marked. Informed consent discussed and signed including the risks of not limited to, pain, infection, bleeding, weakness, stiffness, numbness, tingling, re-tear, need for further surgery, loss of limb or life. The patient was aware of this and consented for the procedure. The patient was taken to the operative theater, general anesthesia was given. The patient was sterilely prepped and anesthetized in beach chair position. Time-out performed with all personnel. First, a standard posterior and anterior arthroscopic portals were established. There was significant synovitic tissue on the anterior compartment, posterior compartment, as well on the superior labrum. Next, the shaver was introduced. A debridement was performed off the anterior labrum, superior labrum, as well as the anterior compartment at the vicinity of the interval tissue. Subscapularis was found to be intact. The posterior compartment was debrided as well. The posterior labrum was debrided. There was very small amount of loose cartilage, but no exposed bone, this was debrided. The undersurface of the rotator cuff tear was debrided with the motorized shaver. This area was then marked with a PDS suture. After this was done, the medial aspect of the footprint was decorticated, the tear was recessed off the medial footprint approximately 8 mm and this extends for approximately 15-20 mm from anterior to posterior starting just behind the bicipital groove. This was decorticated with the motorized shaver. Next a series of two Arthrex 3.9 corkscrew percutaneous anchors were seated on the medial aspect of the footprint at the anterior and posterior most aspects. Through a separate fascial incision, the subacromial space was entered. There was substantial adhesions in the subacromial space. These were cleared out debriding the bursa, adhesions in the anterior posterior aspect over the rotator cuff. The area of the rotator cuff tearing was probed, there was not found to be full thickness tearing. Thus, the decision was made to proceed forward with a partial repair. The CA ligament was thinned anteriorly and the undersurface of the acromion was cleaned off. There is no subacromial compression visible. Next, we entered back into the joint. A series of two 3.9 Arthrex suture tack knotless anchors were seated at the anterior and posterior aspects of the medial footprint. The repair suture was shuttled into the anchor of the opposite anchor creating a two stranded medial row bridge. This was used intra-articularly to ensure compression of the rotator cuff. After this was tightened adequately, these two repair stitches were placed into one lateral row 4.75 SwiveLock anchor with good tension creating a double row percutaneous partial repair. After this was done, final images were taken intra-articularly was examined and found to be intact and compressed against the medial aspect of the footprint. Next, instruments were removed. The portal sites were closed with interrupted 3-0 Monocryl and Steri-Strips, placed into a dry sterile dressing and sling immobilizer. At the end of the procedure, all sponge, needle, and instrument counts were correct.
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