Arthroscopic Trans-Osseous Tension Band Rotator Cuff Repair

Arthroscopic rotator cuff repair tends to create the impression with patients, physicians, and the general public that it is a uniform technique that is consistently taught and performed the same way all over the world. This simply isn’t true, and one known factor that contributes to failed rotator cuff repairs is surgical skill and experience. Surgical technique has also been shown to be a factor in the risk for both healing and the development of subsequent rotator cuff tear. Although, we have written extensively over the years about rotator cuff tears as well as posted a number of videos about this topic, many patients have asked for a step by step description of the technique they can review…so here it is:

Click here to watch a video about Arthroscopic Rotator Cuff Repair with Graft Reinforcement.

Click here to learn about Rotator cuff Repair - New Techniques and Challenges.

Rotator Cuff Graft Reinforcement Surgical Technique

Postoperative Care

The patient is placed in an abductor pillow type brace for 4 weeks postoperative, performing on gentle pendulum exercises several times each day. No passive motion, including pulleys, wall walks, etc. is utilized. At 4 weeks postoperative, the abductor pillow is discontinued and a supine passive stretching program is initiated focused on gentle multiple session of stretching daily prioritizing deltoid relaxation. No strengthening or upright above shoulder activities are initiated until 12 weeks postoperatively to maximize stress free tendon healing. After 12 weeks postoperatively, activities are progressed based on individualized clinical parameters.
modified lateral decubitus
 
subacromial arthroscopy
 
lateral border of the acromion
 
subacromial debridement
 
tear throughout the rotator cuff
 
anterolateral and posterolateral corners of the acromion
 
shoulder anterolateral portal
 
deltoid fascia
 
medial tendon tears
 
medial trans-osseous sutures
 
rotator cuff tendon
 
shoulder graft
 
anterolateral twisted
 
medial limb of the graft
 
rotator cuff footprint
 
reinforcement for the rotator cuff
 
Author
Vivek Agrawal, MD

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