Dataset Information

Arthroscopic and Fluoroscopic Guidance Removal of Intratendinous Broken Instrument During Rotator Cuff Repair.

ABSTRACT: Instrument breakage during arthroscopic rotator cuff repair is a rare complication of shoulder arthroscopy, especially when the broken instrument has been left inside the tendon part of the rotator cuff. We propose a combined arthroscopy and fluoroscopic guidance technique to ease the removal of the broken instrument and repair the torn rotator cuff after removal.

SUBMITTER: Prasataporn N

PROVIDER: S-EPMC6948112 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Arthroscopic and Fluoroscopic Guidance Removal of Intratendinous Broken Instrument During Rotator Cuff Repair.

Prasataporn Niti N Kongrukgreatiyos Kitiphong K Umprai Vantawat V Laohathaimongkol Thongchai T Itthipanichpong Thun T

Arthroscopy techniques 20190919 10

Instrument breakage during arthroscopic rotator cuff repair is a rare complication of shoulder arthroscopy, especially when the broken instrument has been left inside the tendon part of the rotator cuff. We propose a combined arthroscopy and fluoroscopic guidance technique to ease the removal of the broken instrument and repair the torn rotator cuff after removal. ...[more]

PMID: 31921582

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Project description:Arthroscopic rotator cuff repair can be challenging and requires adequate visualization and space. However, the narrow subacromial space can make difficult to perform tendon release and repair under arthroscopy. Inadequate visualization may lead to inaccurate suture placement, compromising the reduction and fixation of the repaired rotator cuff tendons. Manual or mechanical distraction (using an arm positioner) can be used to increase the working space. However, consistent distraction is very difficult to maintain manually over time due to fatigue, whereas mechanical distraction may overstretch the brachial plexus. To overcome these difficulties, we describe a technique using a specific laminar spreader for subacromial distraction during arthroscopic rotator cuff repair. The arthroscopic laminar spreader, inserted into the subacromial space, is used to distract the humeral head inferiorly from the acromion, improving subacromial space visualization and enabling easily rotator cuff release and repair. The shoulder distraction device improves the surgeon’s performance without surgical assistance and allows reducing the operative time with safety. It can be also used anteriorly (to repair the subscapularis) or posteriorly (to repair the infraspinatus and teres minor) or to perform other procedures like superior capsular reconstruction or additional patch. Technique Video Video 1 Arthroscopic rotator cuff tear repair using an arthroscopic laminar spreader: single-row (tension-band suture) placing anchors in the lateral part of the greater tuberosity. Even though acromioplasty has been performed, there is little space to place the sutures through the cuff tendons. The arthroscopic laminar spreader is placed between the acromion and the tendon of the cuff through the anterolateral portal. Introducing the suture hook through the anteromedial portal, it becomes easy to pass the suture through the tendon because the tendon is under pressure with the laminar spreader. Classical repair procedure is shown, using a grasper to retrieve one of the anchor sutures and the polydioxanone suture, which is used as a shuttle to pass it through the tendon. Both strands of sutures are tied with the use of a sliding-locking knot. The laminar spreader is introducing again for the second suture. The arthroscopic laminar spreader opened more than 4 cm. Under fluoroscopic view, the subacromial space increased with the use of the spreader.

Dataset Information

Arthroscopic and Fluoroscopic Guidance Removal of Intratendinous Broken Instrument During Rotator Cuff Repair.

Publications

Arthroscopic and Fluoroscopic Guidance Removal of Intratendinous Broken Instrument During Rotator Cuff Repair.

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