APEX Shoulder Mastering Surgical Techniques for Clinical Success-Be the Cuff, See the Cuff! Pre and Intra Operative ID of Tear Shape

Video Transcription

Video Summary

Dr. Rob Hartzler of TSAOG Orthopedics discusses pre- and intraoperative identification and repair techniques for various rotator cuff tear shapes. He emphasizes that many large, retracted rotator cuff tears, including massive ones, are operatively repairable, especially in younger, active patients unsuitable for arthroplasty. Preoperative MRI alone has limited predictive value; intraoperative assessment of tear mobility after debridement and mobilization is crucial. Hartzler categorizes tears based on Burkhart’s geometric classification into crescent, longitudinal (L-shaped, reverse L, U-shaped), and massive contracted tears, each requiring specific reduction maneuvers and repair patterns. He highlights advanced techniques like anterior and posterior interval slides to improve mobility in massive tears, the importance of linked double row and margin convergence repairs, and preserving anatomical tissue connections such as the comma tissue during subscapularis repair to facilitate supraspinatus reduction. Visualization via lateral arthroscopic positioning and controlled fluid management is vital to achieve technical success. He underscores patience, tenacity, and careful intraoperative evaluation in managing difficult tears, concluding that with proper technique and equipoise, even challenging rotator cuff tears can be anatomically repaired, leading to excellent patient outcomes.

Asset Caption

Robert Hartzler, MD

Keywords

rotator cuff tear

operative repair

intraoperative assessment

Burkhart classification

interval slides

double row repair

subscapularis repair