Dataset Information

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation.

ABSTRACT: We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The proximal end of the guide is approximated to the greater tuberosity at the cuff footprint, and a complete transosseous tunnel is created with a 2.4-mm drill. An all-suture implant is inserted through this tunnel down to the calcar, and its deployment is visualized under arthroscopy. Gentle traction is applied to the anchor, resulting in a 4-mm concertina of the suture anchor that rests opposed to the medial cortex. The major advantage of this technique is the fixation strength gained from the biomechanically superior cortical bone of the calcar. Furthermore, this method permits greater preservation of bone surface area at the level of the footprint for a larger tendon-to-bone healing surface. This technique also provides an excellent alternative in revision situations.

SUBMITTER: Aramberri-Gutierrez M

PROVIDER: S-EPMC4454820 | biostudies-other | 2015 Apr

REPOSITORIES: biostudies-other

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Publications

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation.

Aramberri-Gutiérrez Mikel M Martínez-Menduiña Amaia A Valencia-Mora María M Boyle Simon S

Arthroscopy techniques 20150420 2

We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The pr ...[more]

PMID: 26052495

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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.

Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.

Dataset Information

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation.

Publications

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation.

Similar Datasets

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