Arthroscopy Technique: Repair of Musculotendinous Junction Rotator Cuff Tears in the Shoulder Using a Dynamic Convergence Suture Bridge Technique.

Musculotendinous junction (MTJ) rotator cuff tears in the shoulder are rare injuries in which the tendon fails medial to its tuberosity attachment. There is difficulty in striking a balance between restoring the length-tension relationship of the tendon while avoiding high suture tension at the repair site. In view of the rare incidences of these tears, there is a paucity of literature on their repair techniques. We seek to share our surgical technique in addressing type A MTJ tears-where the medial muscular tear margin is short but remains adequate for suture bridge repair, whereas the lateral tendon remains on the footprint. We used mattress sutures from the medial row of anchors, threaded through the lateral tendon stump, then passed medially to engage the medial stump, before being fixed to a lateral row in a knotless fashion. Pulling on this pair of sutures will thus bring into closer apposition of both medial and lateral tear margins in a dynamic convergence pattern. Our surgical technique is a safe and effective method of repairing type A MTJ tear that confers improved biological and biomechanical advantage via the formation of a dynamic convergence suture bridging technique in addition to a double-row repair construct.

Human Dermal Allograft Patch Augmentation of Degenerate Rotator Cuff Tendon Using a Single Lateral-Row Technique.

The role of biological augmentation in arthroscopic rotator cuff repair surgery has increased over the years. It has shown favorable healing rates and functional outcomes. Patch augmentation is commonly applied in repairs of massively retracted cuff tears, full-thickness tears, revision repair, or open cuff surgery. There is a paucity of literature on the use of patch augmentation when dealing with a chronic degenerate tendon associated with small-sized cuff tears. In recent years, the resorbable bioinductive bovine collagen implant has gained popularity for its application in partial-thickness tears via an isolated bioinductive repair fashion, without traditional rotator cuff repair. These bioinductive implants, albeit promising in their biological properties for tendon repair, lack structural strength and do not confer similar biomechanical advantages as human dermal allograft. We share our surgical technique for an arthroscopic patch augmentation involving human dermal allograft, using a single-lateral row surgical fixation, to address a degenerate cuff tendon with small-sized rotator cuff tear. We believe that our use of a human dermal patch augmentation conferred increased biomechanical advantage and reduced costs while delivering favorable outcomes for patients in our value-driven care.

Increased preoperative greater tuberosity angle does not affect patient-reported outcomes postarthroscopic rotator cuff repair.

BACKGROUND: The greater tuberosity angle (GTA) is a newly described radiological parameter identified in a 2018 study by Cunningham et al that sought to investigate the effect of GT morphology on cuff tears. Increased GTA has been conceptualized to affect rotator cuff pathology through both extrinsic and intrinsic mechanisms. GTA > 70° was highly predictive of a degenerative rotator cuff tear. This study seeks to examine if increased GTA predicts for worse functional outcomes 2 years postoperatively after arthroscopic rotator cuff repair. METHODS: Between May 2010 and December 2016, 169 patients who underwent arthroscopic rotator cuff repair with subacromial decompression were included in this study. GTA was measured on preoperative radiographs. These patients were evaluated preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Outcomes were assessed with the Visual Analog Scale Pain score, Constant Shoulder Score, and the Oxford Shoulder Score. Power analysis was performed based on the minimal clinically important difference of the Constant Shoulder Score. Statistical analysis was performed by dividing patients into two groups based on GTA: 1) ≤ 70 (control GTA); and 2) >70 (increased GTA) and comparisons were made between the 2 groups. RESULTS: The patients' demographics were comparable between both groups. All 169 patients had statistically significant improvements in all functional scores at 2 years postoperatively. There were no statistically significant differences between the two groups of patients in Visual Analog Scale and functional scores at 3 months, 6 months, 1 year, and 2 year postoperatively. The changes in functional scores from their preoperative baseline were also tabulated, and there were no statistically significant differences between the 2 groups. Finally, there was no significant correlation between GTA with CSS or Oxford Shoulder Score at 2 years follow-up. CONCLUSION: This study represents the largest single series available investigating the influence of GTA on midterm functional outcomes after arthroscopic rotator cuff repair. Although GTA remains a reliable radiographic predictor of rotator cuff tears, the authors conclude that increased GTA does not negatively influence midterm functional outcomes. As there is also no statistical significance between increased GTA vs. control in relative functional gain 2 years postoperatively, corrective tuberoplasty may not be mandatory during arthroscopic repair of cuff tears. Standard arthroscopic double-row rotator cuff repair with subacromial decompression can still be offered as a suitable treatment option.

Do diabetic patients have different outcomes after arthroscopic capsular release for frozen shoulder?

INTRODUCTION: While the exact mechanism of primary adhesive capsulitis is unknown, we know that it has strong associations with diabetes mellitus (DM). Although self-limiting, a significant percentage of patients still have persistent pain and stiffness beyond 3 years. Arthroscopic capsular release (ACR) has been described as a successful intervention for recalcitrant adhesive capsulitis that provides early and long-term recovery. The aim of this study is to investigate the relationship between DM and ACR. METHODS: We reviewed prospectively collected data of 56 consecutive patients with idiopathic frozen shoulder who underwent ACR (360° arthroscopic capsulotomy) under a single surgeon. Range of motion, pain score and shoulder function (Constant Shoulder Score, Oxford Shoulder Score, University of California Los Angeles Shoulder Score) were documented preoperatively and one year postoperatively. Patients were dichotomized into diabetic (n = 32) and non-diabetic patients (n = 24) and compared using a mixed ANOVA design to investigate for differences in outcomes. RESULTS: Both group of patients had significant improvement in range of motion, reduced pain scores and improved shoulder scores one year postoperatively (p = 0.000). Diabetic patients had poorer internal rotation (p = 0.000), forward flexion (p = 0.035) and poorer postoperative Constant Shoulder score (p < 0.05). Otherwise both groups improved equally in all other aspects. CONCLUSION: ACR offered good outcomes in both diabetic and non-diabetic patients in terms of range of motion, pain relief and shoulder function. However diabetic patients had poorer improvement in internal rotation and forward flexion postoperatively. Preoperative counselling and postoperative rehabilitation can be better tailored to treat diabetic patients with idiopathic adhesive capsulitis.