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TitleArthroscopic Rotator Cuff Surgery - J. Abrams, R. Bell (Springer, 2008) WW
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Page 2

Arthroscopic Rotator Cuff Surgery

Page 204

13. Arthroscopic Repair of Subscapularis Tears 187

anterosuperior portal and the upper part of the tendon. The four ends of
sutures are passed, two in one shot and the two others in two alternative
tendon penetrations in order to create a mattress for both sutures. Knots
are tied by grasping the two ends of the same suture in one shot through
the portal in order to avoid a soft tissue interposition as no canula is
used.

For more extended lesions, as in types III and IV, the D portal is used
for visualization, and two E and F anterior portals are used for instrumen-
tation (Figure 13.9). After placement of the most inferior anchor though
the most medial and inferior F portal, the suture is retrieved through E,
the more anterolateral one, in order to give room in F for the penetrating
grasper to be in the best position, as perpendicular as possible, to go
through the tendon and to catch the suture previously positioned behind
the articular surface of it.

When the extension of the tear goes inferiorly, reattachment starts with
a very inferior anchor and the footprint is re-created using a W (Cassio-
peia) technique of re-insertion.

13.4.3.4. Associated Lesions

Before and after repair, as it may reduce an anterior subluxation, it is very
important to check that there is no impingement between the lesser tubero-
sity and the coracoid process by subacromial visualization of the tendon
during internal rotation. If needed, coracoplasty may be indicated to avoid
the impingement.

When the supraspinatus and infraspinatus are torn, subscapularis repair
should be performed first as the tear of the superior cuff allows good access
for subscapularis release and reattachment. In a few cases when supraspi-
natus and subscapularis are both detached from the bone but still attached
together, the more inferior subscapularis is reattached first, then fixation
of both subscapularis and supraspinatus is managed on the same superior
anchor. When the biceps is involved, we perform a tenodesis with a specific
technique of reattachment on an anchor.

13.4.4. Postoperative Management
Postoperatively, patients are immobilized in a sling for isolated subscapu-
laris repair, or with a small resting pillow with around 30º abduction
and flexion for a supraspinatus repair, for 6 weeks. During this period,
only passive motion is allowed with internal rotation to the belly but not
behind the back, external rotation to 0º, nonrestricted forward flexion in
internal rotation. After 6 weeks, nonrestricted active-assisted forward
flexion and rotation is allowed. Muscle reinforcement starts after 3
months.

Page 205

188 L. Lafosse and R. Gobezie

A

coracoid

subscapularis

tuberosity

capsule ligament

glene

B

s
u
b
s
c
a
p
u
l
a
r
i
s

t
u
b
e
r
o
s
i
t
y

Figure 13.9. (A) Subscapularis retracted tear Type III. (B) Anterior view of
repaired subscapularis tendon.

Page 408

392 Index

Tendon-to tuberosity repair (cont.)
patient positioning for, 132
postoperative management with,

140
preoperative planning for, 132
results with, 140–141
setup for, 132
surgical procedure for, 132–140
surgical technique for, 133–140

lateral fixation, 118–126
acromioplasty for, 121
anchor placement for, 123
anchor selection for, 122–123
anesthesia for, 120
complications with, 124
contraindications for, 119
cuff mobilization for, 121–122
glenohumeral joint in, 120–121
indications for, 119
knot tying for, 124
patient positioning for, 120
portals for, 120
postoperative management with,

124–125
preoperative planning for,

119–120
repair site preparation for, 122
results with, 125
subacromial space with, 121
suture passing for, 124
suture placement for, 123–124
suture selection for, 123
tear classification for, 121

medial footprint fixation, 105–116
arthroscopic rotator cuff repair

steps with, 110–115
complications with, 116
contraindications for, 106
indications for, 105–106
instrumentation for, 109–110
patient positioning for, 108–109
postoperative management with,

116
preoperative planning for,

106–107
results with, 116
setup for, 108–109
STaR Quiver® for, 108–109
surgical procedure for, 108–109

surgical technique for, 109–115
ThRevo® anchors for, 110, 112

preoperative planning for, 106–107,
119–120, 132

active range of motion in, 106
Bigliani and Morrison

classification in, 107
imaging studies in, 106–107
MRI in, 107, 120

Tennessee slider, 69, 70
Tenotomy, 314
TGF-β. See Transforming growth

factor beta
ThRevo® anchors, 110, 112
Tissue grasper, arthroscopic repair

with, 17
TissueMend® Soft Tissue Repair

Matrix, 248, 253
clinical/human studies on, 263
comparison of, 254
FDA regulatory status for, 253
preclinical/animal studies on, 256
product description for, 253

Transforming growth factor beta
(TGF-β), tendon healing
involved with, 247, 341

Twinfix™ AB, 47–49
Twinfix™ Quick T, 49–50
Twinfix™ Ti, 49
Two portal cutting block technique,

ASAD surgery with, 95–100

U
UHMW. See Ultra-high molecular

weight polyethylene
Ultra-high molecular weight

(UHMW) polyethylene, 38
Ultrasound

repairability assessed with, 2–3
rotator cuff injury diagnosis with, 339

U-shaped tears
interval slides v. margin convergence

for, 218–219
side-side suturing with, 62–63

V
Vascular endothelial growth factor

(VEGF), tendon healing
involved with, 247

Page 409

Index 393

Vascular system, arthroscopic repair
complications with, 366

VEGF. See Vascular endothelial
growth factor

Viewing portal, suture anchor repair
with, 161

W
Waiting portal, suture anchor repair

with, 161
Weston knot, 69, 70
Working portal, suture anchor repair

with, 161
Wrapping limb, 68

Z
ZCR. See Zimmer® Collagen Repair

Patch
Zimmer® Collagen Repair Patch

(ZCR), 248, 252–253
clinical/human studies on, 262–

263
complications using, 262–263
FDA regulatory status for, 253
preclinical/animal studies on,

256
product description for, 252–253
tendon augmentation indication

with, 248

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