A Technique for a Suture-Based Cable Reconstruction of an Irreparable Posterosuperior Rotator Cuff Tear.

The management of irreparable rotator cuff tears remains challenging. In patients in whom a complete repair cannot be obtained, a partial repair remains an option. The goal of a partial rotator cuff repair is to obtain a stable glenohumeral joint fulcrum by restoring the rotator cable complex.

Addition of Allograft and Acromioclavicular Cerclage Improves Outcomes of Arthroscopic-Assisted Reconstruction of Acromioclavicular Separation With a Single Coracoclavicular Tunnel.

Objective The purpose of this study was to prospectively evaluate the functional outcome and complications of unstable acromioclavicular (AC) joint separations repaired with a single coracoclavicular tunnel utilizing an arthroscopic-assisted curved button technique. Methods Thirty-five patients with a minimum of 12 months follow-up underwent arthroscopic-assisted AC joint reconstruction with suspensory button and 2 mm suture tape fixation using 3 mm tunnels. Functional outcome scores were analyzed preoperatively and at final follow-up with all complications noted.

A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating.

Background: Unstable distal clavicular fractures treated surgically are associated with high failure rates and hardware-related complications. Newer techniques have shown promising early clinical results with fewer hardware complications; however, their biomechanical performance has not been assessed. This study biomechanically compared a distal-third locking plate with 3 newer techniques that incorporate coracoid fixation into the construct.

Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear.

The middle glenohumeral ligament (MGHL) typically contributes partially to the anterior stability of the shoulder. In a very limited number of cases, the MGHL can cause abrasion on the upper edge of the subscapularis causing persistent pain symptoms for patients. The condition is exacerbated by internal rotation of the arm.

Patient-Reported Outcomes of Knotted and Knotless Glenohumeral Labral Repairs Are Equivalent.

We conducted a study to compare the clinical results and operative times of knotted and knotless fixation of anterior and posterior glenohumeral labral repairs and superior labrum anterior to posterior (SLAP) repairs. We retrospectively evaluated data that had been prospectively collected from a Surgical Outcomes System database. Knotted and knotless techniques for 226 repairs (59 isolated anterior labral, 95 posterior labral, 72 SLAP) were compared on patient-reported outcome measures (PROMs), including American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain score, and Veterans RAND 12-Item Health Survey score, obtained before surgery and 6 months and 1 year after surgery.

Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft.

Purpose: The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs).

Methods: A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs. The minimum follow-up was 1 year.

Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Repair.

We have been performing arthroscopic superior capsular reconstruction (SCR) with acellular dermal allograft for almost 2 years. Our techniques are based on Mihata's original concept for SCR, in which he used fascia lata autograft. In this report, we describe our standard arthroscopic technique as well as 2 variations of a "zip-line" technique, which we have found particularly useful for large dermal allografts (grafts that are ≥40 mm in any dimension).

The Arthroscopic Superior Capsular Reconstruction.

In a subset of patients with rotator cuff tears, the glenohumeral joint has minimal degenerative changes and the rotator cuff tendon is either irreparable or very poor quality and unlikely to heal. Reverse shoulder arthroplasty (RSA) is often considered for these patients despite the lack of glenohumeral arthritis. However, due to the permanent destruction of the glenohumeral articular surfaces, complication rates, and concerns about implant longevity with RSA, we believe the superior capsular reconstruction (SCR) is a viable alternative.

Pseudoparalysis From a Massive Rotator Cuff Tear Is Reliably Reversed With an Arthroscopic Rotator Cuff Repair in Patients Without Preoperative Glenohumeral Arthritis.

Background: Pseudoparalysis is defined as active forward flexion less than 90° with full passive motion. There is controversy about the ideal surgical management of a massive rotator cuff tear with pseudoparalysis.

Purpose/hypothesis: The purpose of this study was to prospectively analyze the ability to reverse pseudoparalysis with an arthroscopic rotator cuff repair (ARCR).

Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate.

Purpose: The purpose of this study was to evaluate the incidence of residual pain, outcomes, and the revision rate of arthroscopic proximal biceps tenodesis high in the groove at the articular margin of the humeral head by interference screw fixation.

Methods: Seven surgeons pooled data on patients who underwent an arthroscopic biceps tenodesis at the articular margin by interference screw fixation. All patients had a minimum of 50 weeks' follow-up.

Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations.

Purpose: To evaluate the incidence of associated pathologic shoulder lesions that were addressed surgically in grade 3 acromioclavicular joint (ACJ) dislocations, as well as to compare this incidence between younger and older patients and between acute and chronic cases.

Methods: In this multicenter nonrandomized retrospective study, 98 patients operated on for grade 3 ACJ dislocation underwent concomitant arthroscopic evaluation for the identification and treatment of any associated lesions. The type and treatment of associated lesions were collected in a central database and analyzed.

70° frontal visualization of lateral compartment of the elbow allows extensor carpi radialis brevis tendon release with preservation of the radial lateral collateral ligament.

Purpose: To determine whether the radial component of the lateral collateral ligament (R-LCL) and extensor carpi radialis brevis (ECRB) are consistently visible, using a 70° arthroscope, as parallel structures in the extra-articular space of the elbow, and to evaluate the clinical outcomes of these techniques in a series of patients.

Methods: An arthroscopic ECRB tendon release was performed between 2008 and 2010. Eighteen patients were retrospectively evaluated at a minimum of 24 months' follow-up.

A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans.

Purpose: To determine and propose a systematic approach to evaluating magnetic resonance imaging (MRI) scans for subscapularis tears and compares preoperative MRI interpretations with findings of the same shoulders at arthroscopy.

Methods: The study was composed of 202 patients who underwent shoulder arthroscopy by 1 of 5 orthopaedic surgeons during a 3-month period. All patients had MRI scans performed within 6 months before arthroscopy.

Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair.

Purpose: The purpose of this study was to determine the incidence of clinically significant postoperative stiffness following arthroscopic rotator cuff repair. This study also sought to determine the clinical and surgical factors that were associated with higher rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic lysis of adhesions and capsular release for treatment of patients who developed refractory postoperative stiffness 4 to 19 months (median, 8 months) following arthroscopic rotator cuff repair.

The value of arthroscopy before an open modified latarjet reconstruction.

Purpose: The purpose of this study was to identify the presence of intra-articular pathology in patients undergoing shoulder arthroscopy immediately before modified Latarjet reconstruction for recurrent anterior instability with bone deficiency.

Methods: The records of 33 consecutive patients who underwent shoulder arthroscopy immediately before the modified Latarjet reconstruction were analyzed. Arthroscopy was performed just before the open procedure to identify and treat intra-articular pathology that would otherwise have been missed or not well treated during the routine open anterior approach to the shoulder.

The anatomy and function of the low posterolateral portal in addressing posterior labral pathology.

Purpose: A standard posterior portal allows excellent visualization of the glenohumeral joint but is inadequate for anchor placement because of its parallelism to the glenoid surface. The purpose of this study was to describe the low posterolateral portal for glenohumeral arthroscopy, describe the anatomy of the portal and surrounding structures, and discuss the portal's usefulness in addressing posterior and inferior shoulder pathology.

Methods: Five cadaveric shoulders were dissected after placement of a spear through the low posterolateral portal.

The double-pulley technique for double-row rotator cuff repair.

In an effort to maximize the area of footprint coverage, we developed the "double-pulley technique" for double-row rotator cuff repairs. Two suture anchors are inserted at the articular margin of the greater tuberosity (one anterior and one posterior). All 4 suture strands from each anchor are passed through a single medial point on the torn cuff.

Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement.

Calcific tendonitis is a common disease of the shoulder which usually responds to conservative treatment. In cases unresponsive to conservative management, arthroscopic treatment is sometimes required. While there are several reports on calcifications within the supraspinatus tendon, documented cases involving the subscapularis tendon are rare.

Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs.

Purpose: As arthroscopic rotator cuff surgery has advanced, new techniques have emerged to maximize the biomechanical strength of the repair construct. The double-row repair has been recommended as a means of increasing the contact area of the repaired rotator cuff to the native bone bed. This study attempts to sequentially examine and measure the rotator cuff footprint (in vivo) before cuff repair, after an initial lateral-row repair (before the medial-row sutures are tied), and finally, after the double-row repair.

Arthroscopic subscapularis repair: surgical tips and pearls A to Z.

Arthroscopic subscapularis repair can be technically challenging. This article summarizes a number of technical tips that can greatly simplify and expedite what otherwise might be a daunting surgical procedure. Specific tips and pearls include the following: 1.

What do you do when you have a loose screw?

Purpose: This study seeks to compare the pullout strength of various anchor configurations in an osteoporotic bone model. We have tested and present here a technique designed to augment the pullout resistance of an anchor in poor-quality bone with the use of a second anchor as an interference fit; this report describes our in vivo results with this procedure.

Methods: Four groups of suture anchor constructs were tested.

The suture-weave technique: a method of reloading a deployed unloaded suture anchor.

Many suture anchors hold 2 sutures per anchor. Occasionally during a procedure, 1 of these sutures may be inadvertently pulled out of the anchor eyelet. We describe the technique of rethreading a deployed suture anchor in the event that 1 of the sutures is inadvertently unloaded from the anchor eyelet.