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Arthroscopic "Panorama" View of the Subacromial Space via Deltoid Fascia Release.

ABSTRACT: Proper visualization is of paramount importance during arthroscopic rotator cuff repair. We propose a technique that significantly improves the visualization of the rotator cuff when viewing from the anterolateral or lateral portals. This "panorama" view is obtained by a release of the deep layer of the deltoid fascia, which in turn increases the space between the humerus and the deltoid muscle. This release increases the volume of the subdeltoid bursa, secondarily increasing the field of view of the subacromial space with the camera viewing from the anterolateral or lateral portals. This technical note describes a new technique useful in obtaining an excellent view of the subacromial space proving very useful in both the diagnosis and treatment of rotator cuff pathology.

SUBMITTER: Yalizis M

PROVIDER: S-EPMC5040598 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Arthroscopic "Panorama" View of the Subacromial Space via Deltoid Fascia Release.

Yalizis Matthew M Kruse Kevin K Godenèche Arnaud A

Arthroscopy techniques 20160822 4

Proper visualization is of paramount importance during arthroscopic rotator cuff repair. We propose a technique that significantly improves the visualization of the rotator cuff when viewing from the anterolateral or lateral portals. This "panorama" view is obtained by a release of the deep layer of the deltoid fascia, which in turn increases the space between the humerus and the deltoid muscle. This release increases the volume of the subdeltoid bursa, secondarily increasing the field of view o ...[more]

PMID: 27709061

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Project description:BackgroundArthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression.MethodsWe did a multicentre, randomised, pragmatic, parallel group, placebo-controlled, three-group trial at 32 hospitals in the UK with 51 surgeons. Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons, were eligible for arthroscopic surgery, and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection. Exclusion criteria included a full-thickness torn rotator cuff. We randomly assigned participants (1:1:1) to arthroscopic subacromial decompression, investigational arthroscopy only, or no treatment (attendance of one reassessment appointment with a specialist shoulder clinician 3 months after study entry, but no intervention). Arthroscopy only was a placebo as the essential surgical element (bone and soft tissue removal) was omitted. We did the randomisation with a computer-generated minimisation system. In the surgical intervention groups, patients were not told which type of surgery they were receiving (to ensure masking). Patients were followed up at 6 months and 1 year after randomisation; surgeons coordinated their waiting lists to schedule surgeries as close as possible to randomisation. The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at 6 months, analysed by intention to treat. The sample size calculation was based upon a target difference of 4·5 points (SD 9·0). This trial has been registered at ClinicalTrials.gov, number NCT01623011.FindingsBetween Sept 14, 2012, and June 16, 2015, we randomly assigned 313 patients to treatment groups (106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment). 24 [23%], 43 [42%], and 12 [12%] of the decompression, arthroscopy only, and no treatment groups, respectively, did not receive their assigned treatment by 6 months. At 6 months, data for the Oxford Shoulder Score were available for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment. Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months (decompression mean 32·7 points [SD 11·6] vs arthroscopy mean 34·2 points [9·2]; mean difference -1·3 points (95% CI -3·9 to 1·3, p=0·3141). Both surgical groups showed a small benefit over no treatment (mean 29·4 points [SD 11·9], mean difference vs decompression 2·8 points [95% CI 0·5-5·2], p=0·0186; mean difference vs arthroscopy 4·2 [1·8-6·6], p=0·0014) but these differences were not clinically important. There were six study-related complications that were all frozen shoulders (in two patients in each group).InterpretationSurgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process.FundingArthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England).

Dataset Information

Arthroscopic "Panorama" View of the Subacromial Space via Deltoid Fascia Release.

Publications

Arthroscopic "Panorama" View of the Subacromial Space via Deltoid Fascia Release.

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