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The "Pull-Over" Technique for Arthroscopic Superior Capsular Reconstruction.

ABSTRACT: The management of irreparable rotator cuff tears is a difficult problem to deal with. The options include nonoperative route with anterior deltoid exercises, debridement with or without long head of biceps tenotomy, partial rotator cuff repair, tuberoplasty, muscle transfer, patch augmentation, biodegradable spacers, and reverse shoulder arthroplasty. None of these options are without their limitations. In recent years, arthroscopic superior capsular reconstruction has gained popularity as an alternative technique to address irreparable rotator cuff tears. Arthroscopic superior capsular reconstruction, however, is technically difficult. The purpose of this technical note is to describe a simple and reproducible technique for this procedure that addresses some of the challenges involved.

SUBMITTER: Narvani AA

PROVIDER: S-EPMC5439159 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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The "Pull-Over" Technique for Arthroscopic Superior Capsular Reconstruction.

Narvani A Ali AA Consigliere Paolo P Polyzois Ioannis I Sarkhel Tanaya T Gupta Rohit R Levy Ofer O

Arthroscopy techniques 20161219 6

The management of irreparable rotator cuff tears is a difficult problem to deal with. The options include nonoperative route with anterior deltoid exercises, debridement with or without long head of biceps tenotomy, partial rotator cuff repair, tuberoplasty, muscle transfer, patch augmentation, biodegradable spacers, and reverse shoulder arthroplasty. None of these options are without their limitations. In recent years, arthroscopic superior capsular reconstruction has gained popularity as an al ...[more]

PMID: 28560141

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Project description:Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However, difficulty in preoperative graft measurement and intra-articular knot-tying present an obstacle for most sport surgeons. Complementing the known advantages of the transosseous technique in rotator cuff repair, a feasible, economical arthroscopic transosseous superior capsular reconstruction technique is described in this Technical Note. This procedure results not only in similar fixation strength and stability and greater bone stock but also in greater cost effectiveness due to using fewer anchors. This Technical Note describes the procedure in detail and compares it with conventional procedures. Technique Video Video 1 Patients undergo surgery in the beach-chair position. A standard posterior portal is created for arthroscopic visualization. Intra-articular management, including debridement or labral reattachment, is performed via the anterior portal. Then, the scope is shifted to the subacromial space from the posterior portal, and bursectomy is undertaken via the anterior portal. The irreparable cuff tear edge is debrided to approach the medial aspect of the superior labrum. Two inlets are created: one anterior inlet near the biceps groove and one 2-cm inlet posterior to the anterior tunnel inlet. The ETHIBOND 5-0 suture needle tip is visible through the posterior portal and is grasped using a curved needle holder introduced via the lateral portal. The needle tip is introduced into the medial row inlet with a needle holder, and the lateral humeral cortex is pierced. The scope is shifted to the subdeltoid space for retrieval of the needle tip using the curved needle holder through the lateral portal. The ETHIBOND suture is left in the tunnel for shuttle purposes. Next, 3.7-mm all-suture anchors are fixed at the superior glenoid. Single-limb sutures are retrieved from 2 anchors outside via the lateral portal, and the proximal allograft edge is pierced. The graft is delivered along two sutures of glenoid-fixed anchors using a knot pusher. Glenoid graft fixation is achieved by tying knots at each all-suture anchor. After corner knots are tied, an extra knot is tied at the center of the proximal graft edge using each of the corner sutures. Suture tunnel entry points are located using the scope to determine the following piercing site on the graft. The graft undergoes intra-articular piercing, and tunnel sutures are relayed on the proximal and distal row using a tissue penetrator and shuttle suture manipulation. Four sutures are passed through 2 suture tunnels, one of which crosses 2 tunnels in the proximal region to form a medial row of footprint sutures. The shoulder is placed in a neutral position to lessen suture tension. The lateral row is tied first on the lateral cortex, simultaneously applying tension to suture tunnel exits and the medial row. The superior limb of the posterior cross-link suture and the inferior limb of the anterior cross-link suture are retrieved and tied together. The inferior limb of the posterior cross-link suture and superior limb of the anterior cross-link suture are tied to finish the cross-link construction. The final “hourglass” shape construction is achieved after tuberosity fixation.

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The "Pull-Over" Technique for Arthroscopic Superior Capsular Reconstruction.

Publications

The "Pull-Over" Technique for Arthroscopic Superior Capsular Reconstruction.

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