Arthroscopic transosseous reinsertion of the rotator cuff.

Universitätsklinik für Unfallchirurgie, Paracelsus Privatmedizinische Universität Salzburg, Müllner Hauptstrasse 48, A-5020, Salzburg, Osterreich.
Operative Orthopädie und Traumatologie (Impact Factor: 0.57). 04/2006; 18(1):1-18.
Source: PubMed

ABSTRACT Arthroscopic reinsertion of the supraspinatus and infraspinatus tendons by means of imitation of an open transosseous reinsertion technique.
Tears in the tendon cuffs of the supraspinatus and infraspinatus muscles. Patients < 75 years of age.
Retracted tendons that cannot be sufficiently mobilized to provide a tension-free reinsertion. Tears of the tendon cuff of the subscapsularis muscle.
The free edges of the tendons are sparingly resected. The tendon attachment site on the greater tuberosity is freed of soft tissue and decorticated using an arthroscopic bone burr. A full-radius burr is used to drill insertion sites for the sutures in the tuberosity. A hollow needle is inserted percutaneously to puncture the free edges of the tendon for a single reinsertion suture. The hollow needle is then fed through the greater tuberosity to the lateral portal. The suture is guided through the needle and advanced via a working cannula. If the tear is > 2 cm in width, a mattress suture should be placed via another channel in the bone. This is to provide plane contact of the tendon to the reinsertion site.
Restriction of movement using a shoulder bandage for 6 weeks after the operation.
In the 75 patients treated using a single suture, there was an improvement compared to the related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).

  • Source
    Clinical Orthopaedics and Related Research 12/2013; 472(3). DOI:10.1007/s11999-013-3434-4 · 2.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair. After acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures. We investigated the retear rate (based on MR images at least 1 year after the procedure), total score on the UCLA Shoulder Rating Scale, axillary nerve preservation, and issues concerning bone tunnels with this technique in 384 shoulders in 380 patients (174 women [175 shoulders] and 206 men [209 shoulders]). Minimum followup was 2 years (mean, 3.3 years; range, 2-7 years). Complete followup was achieved by 380 patients (384 of 475 [81%] of the procedures performed during the period in question). The remaining 91 patients (91 shoulders) do not have 1-year postsurgical MR images, 2-year UCLA evaluation or intraoperative tear measurement, or they have previous fracture, retear of the rotator cuff, preoperative cervical radiculopathy or axillary nerve palsy, or were lost to followup. Retears occurred in 24 patients (24 shoulders) (6%). The mean overall UCLA score improved from a preoperative mean of 19.1 to a score of 32.7 at last followup (maximum possible score 35, higher scores being better). Postoperative EMG and clinical examination showed no axillary nerve palsies. Bone tunnel-related issues were encountered in only one shoulder. Our technique has the following advantages: (1) reoperation is easy in patients with retears; (2) surgical materials used are inexpensive polyester sutures; and (3) no knots are tied onto the rotator cuff. This low-cost method achieves a low retear rate and few bone tunnel problems, the mean postoperative UCLA score being comparable to that obtained by using an arthroscopic anchor suture technique. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 07/2013; 471(11). DOI:10.1007/s11999-013-3148-7 · 2.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Einleitung Die arthroskopische RM-Rekonstruktion ist weniger invasiv als die transossäre Technik. Sie beruht meist auf der Verwendung von Nahtankern und ist mit spezifischen Nachteilen sowie erheblichen Kosten verbunden. Um die Vorteile der arthroskopischen und transossären Rekonstruktion zu kombinieren, wurde die Arthroscopic-Bone-Needle neu entwickelt. Diese Studie soll die klinischen Resultate und die kurzfristige Rerupturrate nach arthroskopischer RM-Rekonstruktion mit der Arthroscopic-Bone-Needle-Technik aufzeigen. Material und Methoden Insgesamt 66 Patienten mit einer Supraspinatus(SSP)-Ruptur wurden mit der Arthroscopic-Bone-Needle behandelt. In einer separaten Studie wurde die Rerupturrate nach RM-Rekonstruktion mittels MRT ausgewertet. Die Arthroscopic-Bone-Needle ähnelt der Giant Needle®. Allerdings wurden Verbesserungen sowohl im Design als auch im Material vorgenommen. Auch die Operationstechnik wurde grundsätzlich verändert. Ergebnisse Insgesamt 60 Patienten wurden etwa 1 Jahr nach der Operation untersucht. Der durchschnittliche Constant-Score (CS) betrug 73 (normalisierter CS: 92%). Es trat keine Schädigung des N. axillaris oder Fraktur des Tuberculum majus auf. Insgesamt 56 Patienten (93%) waren mit dem Operationsergebnis zufrieden oder sehr zufrieden. Die Materialkosten einer SSP-Rekonstruktion wurden durch die Verwendung der Arthroscopic-Bone-Needle im Vergleich zu Nahtankern um 80% reduziert. Im MRT zeigte sich bei 2 Patienten (10%) eine Reruptur. Schlussfolgerung Die Arthroscopic-Bone-Needle ist eine neue und kostengünstige Methode zur RM-Rekonstruktion mit guten klinischen Ergebnissen und einer akzeptablen Rerupturrate.
    Arthroskopie 05/2012; 25(2). DOI:10.1007/s00142-011-0664-x