AANA Lab Course 1001 - Foundations in Arthroscopy (Resident/Fellow)-ARTHROSCOPIC SUBACROMIAL DECOMPRESSION,DISTAL CLAVICLE EXCISION AND ROTATOR CUFF REPAIR PREPARATION_SURGICAL TECHNIQUES- Richard K.N. Ryu, M.D.

ARTHROSCOPIC SUBACROMIAL DECOMPRESSION,DISTAL CLAVICLE EXCISION AND ROTATOR CUFF REPAIR PREPARATION_SURGICAL TECHNIQUES- Richard K.N. Ryu, M.D.

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Pdf Summary

The AANA Foundations Course (January 16-18, 2020, Chicago) led by Richard Ryu, MD, focused on surgical techniques for arthroscopic subacromial decompression (ASD), distal clavicle excision (EDC), and rotator cuff repair (RCR) preparation. The course emphasized critical evaluation of impingement pathology and questioned traditional acromioplasty approaches, highlighting that not all rotator cuff tears (RCT) are due to impingement nor always require ASD.<br /><br />Key points include recognizing the dilemma whether bony spurring causes impingement or results from it due to humeral head migration. A common sense approach was advocated: confirming subacromial pathology before ASD; if full-thickness RCTs occur without arch changes, ASD may not be necessary. Contraindications for ASD include instability, irreparable tears, and compromised acromial architecture.<br /><br />Surgical techniques were detailed for both ASD (Ellman and Sampson approaches, including the cutting block method) and distal clavicle excision, with specific attention to preserving capsular stabilizers and ensuring appropriate bone resection (6-8 mm). Postoperative rehabilitation involves limited range of motion for 3-4 weeks followed by strength and scapular exercises, with return to activity at 8 weeks if pain-free.<br /><br />The course underscored the importance of preoperative imaging (X-rays and MRI) to evaluate acromial shape, tear size, and pattern to guide repair strategies. Tear patterns described included crescent, L-shaped, massive, and retracted U-shaped tears, each impacting surgical planning. The recognition of tear pattern was deemed critical for repair outcomes.<br /><br />Regarding rotator cuff repair, discussions included the advantages and disadvantages of bursectomy, with an emphasis on minimal removal to preserve healing potential. The single-row modified Mason-Allen suture technique was favored, with consideration of individual cases for single- versus double-row repairs.<br /><br />In summary, effective management requires careful diagnostic verification, individualized surgical planning, and attention to tear pattern and tissue condition to optimize rotator cuff repairs and associated procedures.

Keywords

AANA Foundations Course

arthroscopic subacromial decompression

distal clavicle excision

rotator cuff repair

impingement pathology

acromioplasty

rotator cuff tears

surgical techniques

postoperative rehabilitation

preoperative imaging