Management of the “Irreparable” Rotator Cuff Tear without Glenohumeral Arthritis (AANA19)-Limited Options_ Is there a Role_ Tear Pattern Recognition, Debridement and Partial Repair for Rotator Cuff Tears-Dr. Michael Thomas Freehill, M.D.

Limited Options_ Is there a Role_ Tear Pattern Recognition, Debridement and Partial Repair for Rotator Cuff Tears-Dr. Michael Thomas Freehill, M.D.

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Video Transcription

Video Summary

This discussion focuses on managing massive rotator cuff tears, particularly when partial repair is necessary due to tear size and tissue quality. Pain worsens as tears extend posteriorly, involving the subscapularis and disrupting force couples. Treatment decisions depend on patient factors like age, social habits, and previous surgeries. Partial repairs, even when complete restoration is impossible, significantly improve function compared to simple debridement. Techniques to optimize repair include medializing the medial row by up to 1 cm to enhance tendon-to-bone contact without losing biomechanical advantage, using convergent sutures for tendon edge approximation, and employing a luggage tag suture configuration to distribute pressure and improve fixation security. Arthroscopic anchor selection and knot tying strategy also influence outcomes. Case examples highlight thorough releases and fresh bone preparation to facilitate tendon healing. Overall, partial repair offers cost-effective, functionally beneficial treatment for large rotator cuff tears, with nuanced surgical techniques tailoring repairs to individual patient anatomy and tear characteristics.

Asset Caption

Instructional Course Lecture: Management of the “Irreparable” Rotator Cuff Tear without Glenohumeral Arthritis

Keywords

massive rotator cuff tears

partial repair

medializing medial row

convergent sutures

arthroscopic anchor selection