AANA Lab Course 915 - Foundations in Arthroscopy-How To_ FAST Rotator Cuff Model & Mini-Open Cuff Repair-Robert A. Pedowitz, MD, PhD

How To_ FAST Rotator Cuff Model & Mini-Open Cuff Repair-Robert A. Pedowitz, MD, PhD

Pdf Summary

This document outlines the surgical principles and techniques for rotator cuff repair using the FAST rotator cuff model and mini-open repair approach, authored by Dr. Robert A. Pedowitz. Key surgical steps include identifying and assessing the tear pattern, planning the repair strategy, removing bone spurs, mobilizing tendons, stimulating a healing response, and ensuring stable and strong fixation. Controlled rehabilitation follows to optimize recovery.<br /><br />Tips for efficient repair emphasize using accessory portals, precise anchor placement, organized suture management, and strategic knot tying through cannulas. The FAST workstation setup allows for side-to-side, single-row, and double-row repairs, with examples showing anchor and suture configurations to achieve secure fixation.<br /><br />The mini-open technique involves a deltoid split and rotating the humerus under the incision to expose the tear, differentiating it from arthroscopic methods. While mini-open repairs may cause more early postoperative pain and involve a larger incision, arthroscopic repairs are technically demanding and time-consuming, with no significant difference in long-term outcomes.<br /><br />Surgical details include a longitudinal incision, deltoid splitting, bursectomy, tendon mobilization via traction sutures, cortex stimulation, and achieving stable repair to bone. Fixation options vary: “anchors first” involves placing anchors then passing sutures, while “sutures first” involves placing sutures through the cuff before inserting anchors. Sutures can also be tied over cortical bone bridges or through bone tunnels, especially useful for poor bone quality.<br /><br />Postoperative care mirrors arthroscopic protocols, recommending avoidance of active abduction for six weeks and resisted abduction for twelve weeks, with immobilization tailored to the tear size, tissue quality, and surgeon confidence. This comprehensive approach balances technical precision with physiological healing facilitation for optimal rotator cuff repair outcomes.

Keywords

rotator cuff repair

FAST rotator cuff model

mini-open repair technique

surgical principles

tear pattern assessment

anchor placement

suture management

deltoid splitting

postoperative rehabilitation

tendon mobilization