Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair.

PURPOSE: The purpose of this article is 2-fold: To report the long-term functional results of arthroscopic rotator cuff repair (average, 3.5 years in this study), and to analyze results by tear size and repair technique (margin convergence v direct tendon-to-bone repair). TYPE OF STUDY: Case series. METHODS: Between September 1993 and April 1997, 62 patients had an arthroscopic rotator cuff repair performed by the senior author (S.S.B.). Of this group, 59 patients (59 shoulders) were available for follow-up. Preoperative and postoperative function were assessed by means of a modified UCLA scoring system. Tears were categorized according to size (greatest diameter, number of tendons involved, and pattern of tear [crescent shape v U-shape]). Crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears were repaired by a margin-convergence technique. RESULTS: Good and excellent results were achieved in 95% of the cases, regardless of tear size. The large and massive tears did as well as the small and medium-sized tears. That is, results were independent of tear size (P >.05). Results of tears repaired by margin convergence were not significantly different statistically from those repaired by direct tendon-to-bone repair (P >.05), validating the selection criteria of U-shaped tears for repair by margin convergence. There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for each tear size). Delay from injury to surgery, even of several years, did not adversely affect surgical outcome. CONCLUSIONS: (1) Arthroscopic rotator cuff repair can achieve good and excellent results in a large percentage of patients (95% in this series). (2) Results of arthroscopic rotator cuff repair are independent of tear size. (3) U-shaped tears repaired by margin convergence have results comparable to those of crescent-shaped tears repaired directly by a tendon-to-bone technique. (4) There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for all tear sizes). (5) A delay from injury to diagnosis, even of several years, is not a contraindication to arthroscopic rotator cuff repair.

Turbulence control as a factor in improving visualization during subacromial shoulder arthroscopy.

Bleeding in the subacromial space is an annoying but ever-present impediment to visualization during arthroscopic subacromial procedures. Direct (thermal electrocautery) and indirect (hypotensive anesthesia, arthroscopic pump) means of bleeding control have been used with varying degrees of success. However, the simplest technique of all has been ignored until now. Application of Bernoulli's Principle to achieve turbulence control by means of digital pressure over a leaking portal can quickly and easily enhance visualization.

Articular arc length mismatch as a cause of failed bankart repair.

The purpose of this article is to recognize an often overlooked cause of failed anterior stabilization procedures of the shoulder. Hill-Sachs lesions are common occurrences after anterior dislocation. But despite the frequency of occurrence, they are commonly not addressed in the treatment of recurrent anterior dislocation. The Hill-Sachs lesion produces a shortened rotational arc length of the humeral head on the glenoid; any engagement of the defect with the glenoid produces a sensation in the patient of subluxation/dislocation. However, instead of subluxation/dislocation, the sensation may be caused by mismatch between the articular arc length of the humeral head and the glenoid. The literature concerning the Hill-Sachs lesion and its association with recurrent dislocation has been reviewed. There is no recognition in the literature of this articular arc length mismatch as a cause of failed anterior stabilization procedures. We present a case in which a Hill-Sachs lesion was the cause of a perceived recurrent subluxation/dislocation of the shoulder.