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Arthroscopic rotator cuff repair using modified Arthrex suture-bridge technique

Overview

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Rotator cuff tears are a relatively common cause of shoulder pain from the subacromial space.  The rotator cuff disease that may result in tears can be thought of in the main as resulting from either intrinsic or extrinsic factors or a combination of the two.

Intrinsic disease occurs due to a patient’s biological and genetic makeup, resulting in disorganisation of the collagen within the tendon, which degenerates and detaches from its bony footprint on the proximal humerus.  Extrinsic causes are thought to be attritional wear from repetitive rotation and movement against a thickened coracoacromial ligament and subacromial bony spur, resulting in rupture of the rotator cuff tendon attachment to the proximal humerus. Rotator cuff tears can also come about as a result of direct injury,  with a fall or wrenching force to the joint or even a direct blow to the effected shoulder. 

Rotator cuff tears can be further categorised as partial thickness or full thickness tears. The latter is a complete deficit of the tendon with detachment from the bone whereas the former describes fraying and scuffing of the upper (bursal) aspect or under (articular surface) aspect of the tendon.  There may also be an element of intrinsic intra-substance change within the tendon structure which may only be apparent on cross-sectional imaging such as MRI scan. 

Much has been published in the orthopaedic literature concerning the management of rotator cuff disease and tears and despite this its management is controversial with fervent supporters of both conservative and surgical treatment.  Many shoulder surgeons will advocate surgical repair of a torn or detached tendon once conservative measures have been proven to be unsuccessful.  The exact surgical technique varies with surgeons’ preference and ability and there is little evidence to suggest that different surgical techniques have widely different surgical outcomes. 

The technique I describe here is one I use for a small to medium sized full thickness rotator cuff tear. I also use the same technique when taking down a partial thickness tear and fully detaching it to allow a radical debridement of degenerate tendon from its insertion.   The tendon repair is then supplemented with subacromial decompression as demonstrated in this operative technique.

Readers will also find of interest Mark Crowthers’ related technique Arthroscopic subacromial decompression


Author: Mark Crowther FRCS

Institution: The Avon Orthopaedic centre, Southmead hospital, Bristol,UK.


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