AANA Lab Course 915 - Foundations in Arthroscopy-ARTHROSCOPIC ASSISTED MINI OPEN ROTATOR CUFF REPAIR-John Orwin, M.D.

ARTHROSCOPIC ASSISTED MINI OPEN ROTATOR CUFF REPAIR-John Orwin, M.D.

Pdf Summary

This presentation by Dr. John F. Orwin outlines an arthroscopic-assisted mini open technique for rotator cuff repair emphasizing minimal invasiveness while allowing effective repair of most tear types. The surgical approach begins with diagnostic arthroscopy of the glenohumeral joint and bursa to address associated intra-articular pathologies (such as SLAP lesions, labral tears, and arthritis) and to evaluate the rotator cuff from both articular and bursal sides.<br /><br />The repair is performed via a small 3-5 cm deltoid splitting incision, preserving the deltoid attachment to the acromion to avoid functional impairment. Tears are classified by location (articular, bursal, or complete) and severity, guiding surgical planning. The mini-lateral approach uses an extension of the mid-lateral portal and careful soft tissue handling to safely access the greater tuberosity without injuring the axillary nerve.<br /><br />Key surgical steps include bursa and soft tissue debridement, mobilization of the cuff, creating a trough in the bare area of the greater tuberosity using a high-speed burr to facilitate tension-free cuff placement, and suture placement with #2 non-absorbable material. Modern suture anchor techniques—such as the Versalok system—allow easier tensioning by placing sutures in the cuff before anchor insertion, avoiding knot tying and improving fixation strength.<br /><br />A modified 3-dimensional Kessler stitch is used for its superior strength compared to standard mattress stitches. Bone tunnels via Linvatec instruments and augmentation with nonabsorbable “Cuff Links” in poor cortical bone improve suture fixation.<br /><br />Postoperative care includes immobilization with an ultrasling for approximately three weeks, the duration adjusted by tear size and repair quality. Early rehabilitation focuses on immediate hand and elbow range of motion, with supervised passive shoulder motion preferred over continuous passive motion to optimize healing.<br /><br />Overall, this combined arthroscopic and mini open technique offers a safe, effective method for rotator cuff repair with good visualization, minimal soft tissue disruption, and strong fixation enabling early rehabilitation.

Keywords

arthroscopic-assisted mini open technique

rotator cuff repair

minimal invasiveness

diagnostic arthroscopy

deltoid splitting incision

suture anchor techniques

Versalok system

3-dimensional Kessler stitch

bone tunnels

postoperative rehabilitation