AOSSM/AANA Specialty Day 2020-My Five Arthroscopic Cuff Repair Tips to Make Your Life Simple

My Five Arthroscopic Cuff Repair Tips to Make Your Life Simple

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Dr. Peter J. Millett presented key tips for arthroscopic rotator cuff repair aiming to simplify the surgical process and improve outcomes. The goals of repair include restoring anatomy and biomechanics, achieving strong fixation, and promoting healing. Advances by 2020 include enhanced suturing methods, linked double-row knotless fixation, and improved smaller anchors and biologically friendly sutures.<br /><br />Five main arthroscopic repair tips were highlighted:<br /><br />1. Patient Selection: Consider tear acuity, size, tendon/muscle quality, healing potential, anatomical factors (e.g., acromial morphology), Worker’s compensation status, and rehab potential. Positive outcome predictors include higher baseline scores and longer follow-up; negative predictors include previous repairs, fatty infiltration, and muscle atrophy.<br /><br />2. Portal Placement/Visualization: Utilize at least four portals (posterior, anterosuperior, anterolateral, posterolateral) strategically positioned to optimize visualization and instrument access while minimizing fluid extravasation. Additional portals may be added as needed.<br /><br />3. Mobilization and Reduction: Recognize tear patterns (crescent, U-, L-shaped, massive) from the posterolateral portal for anatomical repair. Carefully debride and release rotator cuff edges to allow mobility without overaggression. Reduction using graspers and temporary stitches helps restore correct orientation.<br /><br />4. Bone Preparation: Lightly debride footprint until bleeding appears to promote healing, avoiding overzealous decortication to preserve anchor fixation. Techniques like microfracture and marrow stimulation enhance biology. Special anchors assist fixation in poor-quality bone.<br /><br />5. Repair Method: Favor a double-row transosseous equivalent with knotless linked constructs using tape sutures, which are self-reinforcing, reduce suture cut-through, improve vascular inflow, avoid medial knot tension, cause less irritation, and scaffold healing. Medial anchors are placed along the articular margin with lateral anchors lateral to the greater tuberosity. Adapt repair constructs as needed.<br /><br />In summary, understanding shoulder anatomy and biomechanics is essential to restoring function and relieving pain through stable, biologically optimized repairs that enable early rehabilitation and better clinical outcomes.

Keywords

arthroscopic rotator cuff repair

Dr. Peter J. Millett

patient selection criteria

portal placement

tear mobilization and reduction

bone preparation techniques

double-row knotless fixation

biologically friendly sutures

shoulder anatomy and biomechanics

rehabilitation outcomes