Document Detail


Arthroscopic fixation of bursal-sided rotator cuff tears.
MedLine Citation:
PMID:  17084305     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Subacromial decompression and debridement of partial-thickness bursal-sided rotator cuff tears are often reported with a high rate of unsatisfactory outcomes. We describe an arthroscopic procedure to repair partial-thickness bursal-sided rotator cuff tears without converting to a full-thickness tear in patients with a normal articular-sided rotator cuff and an A0B2 or A0B3 pattern of tear (minimum thickness of 25% to 75%). The articular side of the rotator cuff experiences greater tension than the bursal side of the cuff. As such, by leaving the articular footprint intact, we accomplish 3 goals: the intact articular fibers act as an internal splint to protect the bursal-sided repair, a wide and anatomic footprint is recreated, and we are able to minimize any length-tension mismatch because the tissue is not excessively lateralized with repair. After bursectomy and acromioplasty, the frayed edges of the bursal flap are gently debrided and the tuberosity is excoriated to bleeding bone. One or two bioabsorbable anchors are placed, and both sutures are placed through the full thickness of the rotator cuff (one anterior and one posterior) by use of a percutaneous suture lasso in this manner: (1) the lasso is passed through the full thickness of the cuff, and the nitinol wire is shuttled out of a single cannula along with the more medial of the suture limbs; (2) the nitinol wire is then pulled back out of the percutaneous portal along with the suture limb, with the suture being passed through the full thickness of the cuff; and (3) the procedure is repeated for the posterior limb of the suture after a lasso is again passed through the full thickness of the rotator cuff in a more posterior position. This subset of patients is treated with an aggressive rehabilitation protocol because the intact articular rotator cuff fibers act as an internal splint to protect the bursal repair.
Authors:
Andrew B Wolff; David P Magit; Seth R Miller; Jeff Wyman; Paul M Sethi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  22     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-06     Completed Date:  2006-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1247.e1-4     Citation Subset:  IM    
Affiliation:
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
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MeSH Terms
Descriptor/Qualifier:
Absorbable Implants
Acromion / surgery
Arthroscopy / methods*
Bone Wires
Bursa, Synovial / surgery
Debridement
Humans
Lacerations / surgery*
Rotator Cuff / injuries*
Suture Anchors
Suture Techniques

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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