AANA Lab Course 1001 - Foundations in Arthroscopy (Resident/Fellow)-OLC Foundation Cases 2020

OLC Foundation Cases 2020

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The 2020 AANA OLC Foundations Course presented multiple complex shoulder cases emphasizing rotator cuff tears, instability, and reconstruction techniques.<br /><br />Case 1 involved a 49-year-old active male with a history of a high-grade partial articular-sided rotator cuff tear, now presenting with pain and dysfunction despite conservative treatment. Studies show partial rotator cuff tears may heal spontaneously or remain stable, and poor tissue quality does not necessarily predict repair failure. A bio-inductive collagen scaffold applied to the bursal side demonstrated early promising outcomes with pain reduction and healing observed at two years.<br /><br />Case 2 addressed irreparable massive rotator cuff tears with pseudoparesis. Superior Capsule Reconstruction (SCR), especially with dermal allografts or fascia lata, showed promise in restoring active forward elevation and improving pain and function. Patient selection criteria include younger age, minimal arthritis (Hamada stage 1 or 2), and repairable subscapularis. Complication rates exist but graft healing correlates with better outcomes. Subacromial spacers provide another treatment alternative for older patients with irreparable tears.<br /><br />Case 3 described recurrent anterior instability after prior stabilization procedures, with imaging showing attenuated anterior capsule and moderate Hill-Sachs lesions. Treatment options include revision arthroscopic Bankart, open bone graft procedures, or allograft repairs based on pathology.<br /><br />Case 4 involved a 21-year-old male with multidirectional instability and voluntary subluxation with failed physical therapy. Surgical options discussed included capsular shifts and arthroscopic labral repairs, yet voluntary instability tends to have poorer outcomes and potential for recurrent symptoms.<br /><br />Case 5 highlighted a 28-year-old male with multiple shoulder dislocations and a 360° humeral avulsion of the glenohumeral ligament (HAGL) lesion. Combined arthroscopic Bankart, HAGL repair, and possible Latarjet procedures are considered tailored approaches.<br /><br />Case 6 reviewed a retired firefighter with a massive retracted rotator cuff tear and pseudoparesis, where partial repair, tendon transfer, SCR, or reverse shoulder arthroplasty were treatment considerations.<br /><br />Case 7 presented an acute shoulder injury evaluated for type of acromioclavicular joint separation, with treatment ranging from conservative to surgical options like open repair or ligament reconstruction.<br /><br />Overall, the course highlighted evolving evidence favoring biologic augmentation in partial tears, SCR for irreparable cuff tears, individualized surgical planning for instability, and careful patient selection to optimize functional outcomes in complex shoulder pathology.

Keywords

rotator cuff tears

shoulder instability

Superior Capsule Reconstruction

biologic augmentation

arthroscopic Bankart repair

Humeral avulsion of the glenohumeral ligament (HAGL)

subacromial spacers

acromioclavicular joint separation

shoulder reconstruction techniques

multidirectional instability