Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique

Waibl, Bernhard; Buess, Eduard

doi:10.1016/j.arthro.2004.11.008

Cited by 76 publications

(60 citation statements)

References 10 publications

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“…The authors [3] reported promising short term result in 8 patients with their anchorless technique. They caution against non-anatomic fixation of the infraspinatus inside the bare area, which might restrict motion and thus diminish performance in throwing athletes Although these techniques seem to have had some success, we share the opinion, that a secure fixation of the tendon to bone is a prerequisite for a stable construct, that allows for a favorable biologic healing environment [6,7].…”

Section: Clinical Experiencementioning

confidence: 99%

“…After a standard diagnostic evaluation of the joint and the subacromial space we place 2 cannulas: a 5 mm cannula in the posterior standard portal to provide easy repetitive access to the glenohumeral joint and a 8.25 mm working cannula in the lateral subacromial portal to assist with bursectomy and suture management. For the visualisation of the subacromial space we prefer a posterolateral viewing portal [6]. Intraarticular debridement with the shaver in the rotator interval will help to delineate the tear from healthy tissue.…”

Section: Operating Techniquementioning

confidence: 99%

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Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Martínez¹,

Buess²,

Hernandez³

2012

OJO

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Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.

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Section: Clinical Experiencementioning

confidence: 99%

Section: Operating Techniquementioning

confidence: 99%

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Martínez¹,

Buess²,

Hernandez³

2012

OJO

Self Cite

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“…The transtendon repair technique allows restoration of the medial side of the footprint while also maintaining the bursal layer of the torn cuff. 15,16 Castagna et al 7 have linked the effectiveness of the transtendon repair technique to decreased tendon retraction, large footprint exposure, younger patients, and a clinical history of trauma. According to another study, the transtendon repair technique reduces pain.…”

Section: E590mentioning

confidence: 99%

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

Bozkurt

Fırat

Gürsoy

et al. 2015

Arthroscopy Techniques

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The frequency of partial rotator cuff tears is gradually increasing because of the advancements in imaging methods and arthroscopy techniques. One of the repair techniques is repair of the partial rotator cuff tear by conversion to a full-thickness tear. Another technique, the transtendon technique, has some practical challenges and risks. We attempted to develop a practical and easy technique with low morbidity to repair partial tears called the rotator cerclage technique.T he level of knowledge and the rate of establishing a distinctive diagnosis for partial rotator cuff tears have increased in line with widespread adoption of humeral arthroscopy and advanced magnetic resonance imaging methods. The best treatment plan for symptomatic partial rotator cuff tears remains uncertain. 1 Previously, debridementdboth with and without acromioplastydwas the standard treatment, 2,3 but this is being replaced by the repair of lesions in excess of 6 mm (grade 3) or those larger than 50% of the tendon thickness. 4 The most recent debate is inclined toward the conversion from a partial-to full-thickness tear and repair of the tear 5,6 or transtendon repair. 7,8 Both methods result in functional recovery and relief, but repairing the tear results in lower morbidity and earlier recovery whereas the tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better in the case of transtendon repair, which keeps the bursal side intact. 9 The transtendon repair techniques described so far involve some challenges in surgical implementation and require experience. Our goal is to develop a practical technique with easy implementation through which a partial tear can be repaired through interventions performed only from the bursal side without converting the tear to a full-thickness tear after the partial tear is identified intra-articularly (Table 1). TechniqueAfter induction of anesthesia, the patient is placed in the beach-chair position. A standard diagnostic arthroscopy is performed with 30 arthroscopic visualization through a posterior portal with a pump (FMS DUO Fluid Management System; DePuy Mitek, Raynham, MA) maintaining a pressure of 50 mm Hg. The supraspinatus insertion to the humerus is inspected in the neutral position with abduction and external rotation of the arm because most tears can be clearly seen at this position (Fig 1). After examination of all glenohumeral structures, the articular-sided supraspinatus tear is debrided with a 5-mm full-radius shaver (DePuy Mitek). The extent of the tear can be estimated based on the size of a shaver blade (the width of the articular side of the supraspinatus is estimated by comparing it with the known width of a 5-mm shaver) or with an arthroscopic ruler. Then, the surgeon inserts Prolene suture (Ethicon, Somerville, NJ) from an 18-gauge spinal needle stretching from the subacromial zone to the joint, ensuring that it passes from the supraspinatus articular tear area, and the Prolene suture proceeds inside the joi...

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“…[10][11][12][13] As recently as 2010, there were no prospective studies and no randomized controlled trials that looked at the clinical outcomes of these different techniques for treatment of PASTA lesions, 14 suggesting that much research remains to be performed in this area.…”

mentioning

confidence: 99%

“…5,11,15 Complete takedown has been found in 1 prospective randomized controlled trial to yield less pain and a quicker functional recovery than a transtendinous repair technique but with a higher incidence of complete failure of the repair. 15 Other studies have supported the idea that transtendinous techniques result in a lower rate of failure while suggesting that the functional outcomes and patient satisfaction after transtendinous repair may be higher than previously thought.…”

mentioning

confidence: 99%

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Caldwell

Elfar

2014

Arthroscopy Techniques

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There is no current consensus in the literature on the optimal technique for surgical treatment of partial articular-sided supraspinatus tendon avulsion (PASTA) lesions, although most techniques described to date require takedown of the partially torn tendon or passage of an anchor through the already damaged tendon. We describe a novel inside-out repair technique for partial articular surface supraspinatus tears that does not require further disruption of the partially torn tendon by passage of an anchor.P artial-thickness rotator cuff tears (PTRCTs) have long been recognized as distinct from full-thickness rotator cuff tears. They have been noted in as many as 26% of asymptomatic patients aged 40 to 60 years 1 but can present with a wide spectrum of symptoms including a higher level of reported pain than fullthickness tears. 2 They have also been noted to occur in the younger population, particularly overhead throwing athletes. 3 Only recently, however, has the literature recognized articular-sided PTRCTs as distinct from bursal-sided PTRCTs in both mechanism and potential treatment modalities. 4 Articular surface PTRCTs are reported 2 to 3 times more commonly than bursal-only PTRCTs in the literature. 5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction. 4 It has been noted that there is a relative hypovascularity of the articular surface of the supraspinatus tendon compared with the bursal surface, which may contribute to the higher incidence of degenerative tearing of the articular surface at the insertion of the supraspinatus. 6 The articular and bursal sides of the supraspinatus differ in their histology as well: The bursal side of the cuff contains mainly tendinous bundles, giving it a greater tensile strength, whereas the articular side is a more complex mixture of ligament, capsule, and tendon. 7 Although the initial treatment for most articular-sided PTRCTs is nonoperative and symptomatically oriented, the natural history of these lesions remains unclear. Cadaveric studies have shown an increase in strain on the remaining intact supraspinatus tendon during abduction when a 33% thickness partial articular-sided supraspinatus avulsion (PASTA) lesion is created, 8 and a serial arthrography study found that 27% of articular-sided tears progressed to full-thickness tears over a 1-year period whereas only 10% appeared to heal completely. 9 This finding suggests that even when nonoperative treatment is successful in resolving symptoms, it is unlikely that this represents healing of the tear. Failure of conservative management is considered an indication for surgical intervention.There is no consensus in the literature regarding the ideal technique for treatment of PASTA lesions, although many techniques have been described, including simple debridement, tear completion and complete repair, and a variety ...

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Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique

Cited by 76 publications

References 10 publications

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

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