AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-How To_ Arthroscopic Rotator Cuff Repair_ Arthroscopic Rotator Cuff Repair Cadaver Including How to Make a Tear and Convert to Mini Open-Dr. Robin M. Gehrmann, MD

How To_ Arthroscopic Rotator Cuff Repair_ Arthroscopic Rotator Cuff Repair Cadaver Including How to Make a Tear and Convert to Mini Open-Dr. Robin M. Gehrmann, MD

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Pdf Summary

This lecture by Dr. Robin M. Gehrmann provides a comprehensive overview of arthroscopic rotator cuff (RTC) repair techniques, tracing their historical development and detailing modern best practices. Early descriptions of RTC tears date back to the late 18th century, but arthroscopic repair has rapidly advanced to enable repair of nearly all tears within 15 years.<br /><br />Key principles from Neer’s 1990 criteria still guide repair: close the defect, eliminate impingement, preserve the deltoid origin, and rehabilitate to avoid stiffness. Arthroscopic RTC repair offers advantages such as less deltoid disruption, better range of motion, minimal visual constraints, and potentially less morbidity and cost, though it demands technical skill and specialized equipment.<br /><br />Preoperative assessment includes detailed tear pattern evaluation via MRI and arthroscopy, which helps classify tears as crescent, U-shaped, or L-shaped, influencing repair technique. The “suspension bridge” biomechanical model highlights the importance of the rotator cable and crescent areas in force distribution and informs repair strategy.<br /><br />Surgical setup involves general anesthesia with possible regional blocks, patient positioning (beach chair or lateral decubitus), careful portal placement guided by anatomical landmarks, bursectomy, and acromioplasty if needed. Repair follows three steps: acromioplasty and bursectomy, tear mobilization/debridement, and tension-free cuff repair to bone using sutures and anchors with attention to restoring balanced force couples.<br /><br />Single-row repairs suffice for small, acute tears with good tissue quality, while double-row repairs provide biomechanical advantages by increasing cuff-footprint contact area and restoring tissue tension, especially in larger tears. However, despite improved structural healing seen on imaging, clinical outcomes do not always differ significantly between single- and double-row repairs. Double-row repairs are more costly, take longer, and may risk blood supply compromise.<br /><br />Postoperative rehabilitation emphasizes early passive motion and scapular strengthening. Outcomes vary by factors such as tear chronicity, fatty infiltration, and patient expectations. Overall, arthroscopic repair minimizes deltoid morbidity and allows precise acromioplasty and tear visualization. The lecture underscores that a good open repair remains better than a poor arthroscopic one, advocating for surgeon comfort and skill dictating technique choice.

Keywords

arthroscopic rotator cuff repair

rotator cuff tear

Neer criteria

rotator cable

acromioplasty

single-row repair

double-row repair

postoperative rehabilitation

MRI tear classification

surgical technique