Arthroscopic trans-osseous rotator cuff repair

Chillemi, Claudio; Mantovani, Matteo

doi:10.11138/mltj/2017.7.1.019

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…Another option to prevent such injuries, as an alternative to the technique of drilling straight tunnels, is to use one of the proprietary devices, such as the Arthrotunneler system (Wright Medical Group) or the Compasso device (NCS Lab), which help create an acute angled tunnel with a vertical limb and a horizontal limb. 4,7,10,18 This results in a tunnel that exits relatively proximal on the lateral aspect of the humerus, along with a thicker bone roof (a deeper tunnel). However, suture cutout through the bone tunnel has been reported even with these devices, with rates as high as 44%.…”

Section: Discussionmentioning

confidence: 99%

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Optimal Angle of the Bone Tunnel for Avoiding Axillary Nerve Injuries During Arthroscopic Transosseous Rotator Cuff Repair: A Magnetic Resonance Imaging–Based Simulation Study

Gupta

Mishra

Kataria

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Axillary nerve injury and suture cutout through the roof of the tunnel are potential complications of arthroscopic transosseous rotator cuff repair (ATORCR).Purpose:To determine a safe angle of drilling for the bone tunnel during ATORCR such that the axillary nerve is not at risk. The thickness of the bone bridge over the tunnel for different angles of drilling was also determined.Study Design:Descriptive laboratory study.Methods:The drilling of a straight tunnel was simulated on 30 magnetic resonance imaging (MRI) scans in the oblique coronal plane by drawing a straight line that passed at a “safe distance” of 5 mm from the axillary nerve and emerging at the medial border of the insertion of the rotator cuff on the greater tuberosity. The angle made by this line with the horizontal axis of the humerus was measured on 3 MRI sections: anterior (passing just posterior to the lateral lip of the bicipital groove), middle (at the most lateral point of the proximal humerus), and posterior (an equal number of cuts away from the middle section as between anterior and middle). The thickness of the overlying bone roof was measured for this line as well as for simulation lines drawn at 50°, 55°, 60°, and 65° with the horizontal axis. A “safe limit,” defined as the mean – 2SD, was also calculated.Results:The axillary nerve was found to be safe, with a safety margin of 5 mm, at drill angles of less than 61.1° and 60.3° in the posterior and middle sections, respectively. The safe limit value for thickness of the overlying bone roof for the tunnel drilled at 60° was 5.0 mm in the posterior section (mean, 8.2 ± 0.3 mm) and 5.5 mm in the middle section (mean, 8.1 ± 0.2 mm). In the anterior section, the minimum safe angle was 57.7°, and the mean thickness of the bone roof for the 55° angle was 6.3 ± 0.2 mm (safe limit, 3.7 mm).Conclusion:Straight bone tunnels in ATORCR surgery should be drilled at an angle of 60° to the horizontal axis of the humerus or 30° to the humeral shaft to ensure the safety of the axillary nerve while at the same time ensuring adequate thickness of the overlying bone roof. The anterior tunnel close to the bicipital groove should be drilled cautiously at 55° to the horizontal axis or 35° to the humeral shaft.Clinical Relevance:The findings of the present study will help the surgeon choose the best angle for drilling tunnels during ATORCR surgery to avoid axillary nerve injuries as well as suture cut-through without the need for any proprietary device.

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Section: Discussionmentioning

confidence: 99%

“…13,21 Over the past few years, many authors have described slightly differing versions of arthroscopic transosseous rotator cuff repair (ATORCR). 2,7,8,13,14,16,21 This method theoretically represents the best of both worlds, having the advantage of a minimally invasive arthroscopic procedure with the strength and cost-effectiveness of transosseous fixation.…”

mentioning

confidence: 99%

Optimal Angle of the Bone Tunnel for Avoiding Axillary Nerve Injuries During Arthroscopic Transosseous Rotator Cuff Repair: A Magnetic Resonance Imaging–Based Simulation Study

Gupta

Mishra

Kataria

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Since April 2015, we have used PGA threads for mattress sutures to gain the initial cuff securing force and avoid excessive tension on the rotator cuff. In addition to our method, other methods for arthroscopic transosseous repair of the rotator cuff without implant using an ArthroTunneler [5][6][7][8][9][10] , hollow needle [11][12][13] , special equipment [14][15] , and anterior cruciate ligament guide [16] have been reported. However, there have been on 4 reports describing clinical outcomes from arthroscopic transosseous repair of the rotator cuff without implant in more than 50 patients [1,10,11,13] .…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Transosseous Suture Without Implant for Rotator Cuff Tears: Absorbable Mattress Sutures Versus Non-Absorbable Sutures

Kuroda

Ishige

Ogino

et al. 2019

International Journal of Orthopaedics

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AIM: In 2005, we developed an anchorless technique for arthroscopic transosseous rotator cuff repair without implant. We aimed to clarify the differences in clinical outcomes and retear rates between patients receiving absorbable mattress sutures and those receiving non-absorbable sutures. MATERIALS AND METHODS: In this retrospective cohort study, we analyzed 131 cases in which absorbable mattress sutures were used and 384 cases in which only non-absorbable sutures were used. Three 2-mm Kirshner wires with perforated tips were inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint. After pulling the rotator cuff stump laterally, 3 Kirshner wires were threaded through the rotator cuff and skin. Five threads were passed through 3 bone tunnels using the perforated tips of the Kirshner wires. The surgery was completed by inserting 2 mattress sutures and 3 bridging sutures. In addition to retear rates, the surgical cost of other transosseous methods was investigated. RESULTS: The retear rate was 3.1% using absorbable mattress sutures and 6% using non-absorbable suture only. It was 12% using the hollow needle method and 3.7% using the ArthroTunneler method. The surgical cost was $9-12 for our procedure, $121 for the hollow needle method, and $600 for the ArthroTunneler method. CONCLUSIONS: We found that using absorbable thread for mattress sutures reduced the retear rate. A big advantage of our technique is that it is inexpensive because the only surgical materials required are suture threads.

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“…All 6 stitches were then passed through the cuff to obtain the "2MC" (or "double MC") configuration with the tape ends passed more anteriorly and posteriorly. 13 Schematically, we refer to limb 1 as the most anterior and to limb 6 as the most posterior. We first closed limb 2 with limb 3 (suture 1) and later closed limb 4 with limb 5 (suture 2), leaving limbs 1 and 6 free.…”

Section: Surgical Techniquementioning

confidence: 99%

“…9 In an attempt to overcome the limitations of anchor repair, arthroscopic transosseous (TO) RC repair techniques have been developed. [10][11][12] In case of bone deficiency of the greater tuberosity, it is possible to use a lateral cortical augmentation device that is able to protect and reinforce the bone itself, 13 without any need to medialize the tendon insertion. 14 Several studies have shown that TO tunnels provide an excellent hold.…”

mentioning

confidence: 99%

Arthroscopic Transosseous Repair of Rotator Cuff Tear and Greater Tuberosity Cysts

Chillemi¹,

Paglialunga

Guerrisi

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the short-term outcomes of rotator cuff repair in the presence of a greater tuberosity cyst (GTC) using a transosseous repair technique. Methods: This study included patients who underwent arthroscopic rotator cuff tear repair with a transosseous technique and were evaluated clinically and by postoperative magnetic resonance imaging (MRI) after 1 year. The inclusion criteria were based on the results of preoperative MRI and were as follows: patients identified as having a repairable full-thickness rotator cuff tear associated with the presence of cystic changes at the tendon insertion site of the greater tuberosity, defined as a GTC involving the footprint area of the torn tendon (supraspinatus and/or infraspinatus tendons). Results: We evaluated 25 patients. The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 39.48 (P ¼ .530) and 84.64 (P ¼ .035), respectively; Constant shoulder scores, 38.96 (P < .005) and 80.28 (P ¼ .425), respectively; and University of CaliforniaeLos Angeles shoulder rating scale scores, 10.6 (P ¼ .045) and 29.04 (P ¼ .315), respectively. The GTC mapping system was easily adopted in all the MRI examinations independently from the quality of the images. The GTCs were mostly located in the superficial anterolateral section of the humeral head and in both the posterolateral sections (superficial and deep). Conclusions: Arthroscopic transosseous rotator cuff repair led to significant mid-term improvement and satisfactory subjective outcomes with low complication and failure rates in this study. The GTC mapping system could be useful to evaluate GTCs and to aid surgeons in the choice of the best surgical technique. Level of Evidence: Level IV, therapeutic case series. G reater tuberosity cysts (GTCs) are often observed in patients with rotator cuff tears (RCTs), with a reported prevalence of 9%. 1 The cysts are occasionally encountered in the anterior (supraspinatus tendon insertion) or posterior (infraspinatus tendon insertion) aspect of the greater tuberosity or in the lesser tuberosity (subscapularis tendon insertion). The anterior location of a cyst is strongly associated with a full-thickness RCT 2 regardless of age. 1 The etiopathogenesis of these cysts is still not completely understood, and several explanations have been reported. They can arise from congenital abnormalities, age-related degeneration, or rotator cuff (RC) pathology. 2-4 The intact tendon insertion may protect against cyst formation by attaching firmly to bone that creates a barrier for the synovial fluid. 5 wIn most cases, the cysts are small and do not interfere with RCT reattachment. 6 In this scenario, placing the tendon stump onto the cyst area or medializing the tendon reattachment allows the problem to be easily overcome. However, when a cyst is large enough and in a critical location, its presence poses a serious challenge during arthroscopic RCT repair. 6 These GTCs may encompass such a large area of the RC footprint that suture anchor fixation can be compr...

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Arthroscopic trans-osseous rotator cuff repair

Cited by 14 publications

References 25 publications

Optimal Angle of the Bone Tunnel for Avoiding Axillary Nerve Injuries During Arthroscopic Transosseous Rotator Cuff Repair: A Magnetic Resonance Imaging–Based Simulation Study

Optimal Angle of the Bone Tunnel for Avoiding Axillary Nerve Injuries During Arthroscopic Transosseous Rotator Cuff Repair: A Magnetic Resonance Imaging–Based Simulation Study

Arthroscopic Transosseous Suture Without Implant for Rotator Cuff Tears: Absorbable Mattress Sutures Versus Non-Absorbable Sutures

Arthroscopic Transosseous Repair of Rotator Cuff Tear and Greater Tuberosity Cysts

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