All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results

Abstract

Background: Traditional intra-articular arthroscopic repair techniques for massive anterosuperior rotator cuff tears are technically demanding and necessitate sacrifice of the rotator interval to enable visualization. An interval slide allows mobilization through release of the medial aspect of the rotator interval, while leaving the lateral, bridging fibers intact. Questions/Purposes: The purpose of this study was to report a novel, arthroscopic, open-equivalent technique using the subdeltoid space to address these tears along with early clinical results. Methods: A retrospective review of prospectively collected data identified 11 consecutive arthroscopic massive anterosuperior rotator cuff repairs with a concomitant biceps tenodesis performed by the senior surgeon using a uniform technique. Outcome measures included range of motion, visual analog scale for pain, rotator cuff strength, American Shoulder and Elbow Surgeons (ASES) outcome scale, and Short Form-12 (SF-12). Results: Average length of follow-up was 22.2 months (range 12.5-30.0 months). Visual analog scale (VAS) pain scores, ASES, and SF-12 all demonstrated significant improvement from pre-op to final follow-up from 6.2 to 0.9 (p < 0.05), 27.4 to 82.8 (p < 0.05), and 26.6 to 45.5 (p < 0.05) respectively. Average forward flexion improved from 145°to 160°(p < 0.05). Seven of the nine patients with a positive preoperative belly press had a negative test at final follow-up. Nine of the 10 patients with a positive lift off test demonstrated a negative test on final follow-up. Ninety-one percent reported they were satisfied with their outcome. Conclusions: The described modified all-arthroscopic subdeltoid approach for anterosuperior cuff repairs enabled an open-equivalent interval slide technique that preserved the bridging lateral fibers of the rotator interval and demonstrated promising early-term clinical results.

Merged Lateral Row Modification of the Suture Bridge Technique for Simultaneous Supraspinatus and Subscapularis Repair

“…14 In their study, Corpus et al. 15 reported a similar technique to fix the suture limbs of both tendons to lateral suture anchors. However, this technique involves 6 loaded sutures in one knotless suture anchor, which is not available in some types of knotless suture anchors.…”

Performance of PROMIS Global-10 Compared With Legacy Instruments for Rotator Cuff Disease

“…The PROMIS Global-10 is similar in design to the 12-Item Short Form Health Survey (SF-12), another general health PRO measure that has been widely used in assessing patients with rotator cuff pathology and their response to treatment. 8,11,24,28,38 The SF-12 is a short-form version of the SF-36 and is similar to the PROMIS Global-10 in that it has both physical and mental component summaries, with high scores indicating better function and with a mean score of 50 for the US population (range, 0-100). 34,35 Ferreira et al 11 found significantly lower SF-12 physical component scores for patients with rotator cuff arthropathy as compared with matched controls and significantly poorer functional results according to the ASES.…”

“…34,35 Ferreira et al 11 found significantly lower SF-12 physical component scores for patients with rotator cuff arthropathy as compared with matched controls and significantly poorer functional results according to the ASES. Corpus et al 8 used the SF-12 to measure response to treatment among patients with massive rotator cuff tears treated with an all-arthroscopic modified rotator interval slide, finding a significant improvement in both postoperative ASES scores and SF-12 physical component scores. Similar to these 2 studies, our data showed decreased PROMIS Global-10 physical function scores among patients with rotator cuff pathology, whereas the PROMIS Global-10 mental function scores were similar to the US population average.…”

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

“…Various procedures have evolved over the years in an attempt to address these difficult clinical situations. 1 Surgical techniques such as arthroscopic debridement, capsular release, 4 , 5 interval slides, 6 , 7 margin convergence, 8 , 9 , 10 and partial rotator cuff repair are commonly used during surgical intervention, with the goal of increasing rotator cuff excursion and therefore humeral head coverage, which will allow restoration of the transverse plane force couples. However, if the native tissue is too deficient or immobile even after attempts at mobilization, one may consider the supplemental use of graft augmentation 11 or reconstruction options including interposition allograft, 12 superior capsular reconstruction, 13 , 14 tendon transfers, 15 or even reverse shoulder arthroplasty.…”