Rotator Cuff Sparing Arthroscopic SLAP Repair With Knotless All-Suture Anchors.
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ABSTRACT:
SUBMITTER: Dekker TJ
PROVIDER: S-EPMC6819747 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization.
| S-EPMC4523664 | biostudies-literature
Project description:Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors. Technique Video Video 1 Arthroscopic repair of a right shoulder rotator cuff repair, subpectoral open biceps tenodesis, and autograft biceps graft augmentation is performed in a beach-chair position. We begin with a diagnostic arthroscopy viewing the subacromial space through the posterolateral portal. The rotator cuff tear is evaluated using a grasper through the lateral portal. The rotator cuff is repaired using a knotless configuration double row transosseous-equivalent beginning with all-suture anchors being placed, creating a medial row. These sutures are then passed through the rotator cuff tear and brought to a lateral row where the final construct is visualized. Next, we perform a mini-open subpectoral biceps tenodesis using a low axillary incision. The proximal biceps tendon is harvested and placed on the back table to be measured for autograft augmentation. The biceps autograft is placed in a compression plate and loaded into the press, where it is “smashed.” Sutures are put into all 4 corners of the graft and loaded onto the delivery device. The patch is inserted into the shoulder through a cannulated lateral portal into the subacromial space and deployed over the rotator cuff repair. The patch is fixated medially using a PLGA tissue tack device and laterally with two anchors. The final repair construct is demonstrated by the autograft patch augmentation lying flush over the rotator cuff repair.
| S-EPMC10466225 | biostudies-literature
Project description:SLAP tears have been a controversial topic in shoulder surgery for decades. The indications for repair of SLAP tears, as well as the methods of repair, have undergone a recent evolution. The use of intra-articular knots for SLAP repair has fallen out of favor because of potential abrasive damage to the rotator cuff and glenohumeral articular cartilage due to knot migration and prominence. In response to this potential iatrogenic injury, arthroscopic techniques have undergone an evolution using advanced techniques with low-profile knotless repairs. We describe our preferred low-profile knotless technique for SLAP repair using LabralTape (Arthrex) in a horizontal mattress configuration.
| S-EPMC7587043 | biostudies-literature
Project description:BackgroundAlthough arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair.Description of techniqueAfter acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures.MethodsWe investigated the retear rate (based on MR images at least 1 year after the procedure), total score on the UCLA Shoulder Rating Scale, axillary nerve preservation, and issues concerning bone tunnels with this technique in 384 shoulders in 380 patients (174 women [175 shoulders] and 206 men [209 shoulders]). Minimum followup was 2 years (mean, 3.3 years; range, 2-7 years). Complete followup was achieved by 380 patients (384 of 475 [81%] of the procedures performed during the period in question). The remaining 91 patients (91 shoulders) do not have 1-year postsurgical MR images, 2-year UCLA evaluation or intraoperative tear measurement, or they have previous fracture, retear of the rotator cuff, preoperative cervical radiculopathy or axillary nerve palsy, or were lost to followup.ResultsRetears occurred in 24 patients (24 shoulders) (6%). The mean overall UCLA score improved from a preoperative mean of 19.1 to a score of 32.7 at last followup (maximum possible score 35, higher scores being better). Postoperative EMG and clinical examination showed no axillary nerve palsies. Bone tunnel-related issues were encountered in only one shoulder.ConclusionsOur technique has the following advantages: (1) reoperation is easy in patients with retears; (2) surgical materials used are inexpensive polyester sutures; and (3) no knots are tied onto the rotator cuff. This low-cost method achieves a low retear rate and few bone tunnel problems, the mean postoperative UCLA score being comparable to that obtained by using an arthroscopic anchor suture technique.
| S-EPMC3792255 | biostudies-literature
Project description:Rotator cuff injuries in the skeletally immature population are uncommon, with most tears resulting from trauma or overuse in throwing athletes. Although the literature has referenced multiple repair methods in the pediatric population, an arthroscopic physeal-sparing technique has yet to be described. Given the proximity of the proximal humerus growth plate to the typical anchor placement during rotator cuff repair, we advocate a technique that avoids violation of the proximal humeral physis. Our technique shows an arthroscopic physeal-sparing repair using standard arthroscopic equipment and fluoroscopy.
| S-EPMC6713816 | biostudies-other
Project description:Glenohumeral bone loss is a significant risk factor for recurrent instability after shoulder dislocation. The Hill-Sachs lesion is an osseous defect of the posterior humeral head that is commonly recognized after anterior shoulder dislocation. Several procedures exist to address humeral-sided bone loss, including soft tissue filling procedures, osteoarticular allografts, bone plugs, rotation osteotomies, and humeral head replacements. However, among the most common of these procedures is the arthroscopic remplissage. This technique involves capsulotenodesis of the posterior shoulder capsule and infraspinatus tendon into a Hill-Sachs lesion. Previously described techniques use knotted suture anchors. In this report, we describe a modified technique for remplissage using knotless, all-suture anchors to perform capsulotenodesis of a Hill-Sachs lesion. Benefits of this technique include a single skin incision, improved bone preservation, and easier facilitation of revision surgery if required.
| S-EPMC9051975 | biostudies-literature
Project description:The double-row suture technique and the suture-bridge technique have been used for rotator cuff repair to decrease the occurrence of retears. However, when only the degenerated tendon end is sutured, the risk of retear remains. The augmentation suture technique is a new procedure that connects the intact medial tendon to the lateral greater tuberosity, and this approach may protect the initial repair site. The procedures for this technique are as follows: 2 sutures are placed through the medial intact tendon, the cuff tear is repaired by the single-row technique, 2 sutures are pulled laterally over the single-row repair site, and 2 sutures are fixed at the lateral greater tuberosity with a push-in-type anchor. This technique is simple and easy and does not require special equipment. Moreover, this approach can augment the single-row repair technique without creating high tension at the cuff end.
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Project description: Not available
| S-EPMC10150159 | biostudies-literature
Project description:Medial meniscus posterior root tears can lead to rapid progression of knee arthritis because of loss of the stress distribution function of the meniscus. Medial meniscus root repair can restore stress distribution and improve clinical outcome. In cases of medial meniscus root tears with meniscal extrusion, centralization may help reduce extrusion and protect the root repair. Presented here is a technique for transtibial medial meniscus root repair with centralization using knotless suture anchors, building on previously developed techniques.
| S-EPMC9052078 | biostudies-literature
Project description:Contemporary arthroscopic double-row suture anchor rotator cuff repairs have superior biomechanics compared with prior iterations. Numerous techniques have been described, but consensus regarding value has yet to be established. We describe an effective and easily reproducible technique: the arthroscopic "Montgolfier double-row" repair technique. This knotless construct has an evenly distributed, load-sharing, radially oriented suture limb configuration much like the envelope cables of a Montgolfier hot-air balloon, its namesake. Other advantages include the ability to apply manual, progressive and calculated tension on each suture limb and easy intraoperative modification depending on tear size, shape, and delamination, as well as tissue tension and quality. Future studies are needed to validate the biomechanics and clinical outcomes of this technique.
| S-EPMC6713846 | biostudies-other