Magdiel Mayol-Urdaz, MD
Orthopedic Surgeon
Fellowship in Sports Medicine
Associate Professor University of Puerto Rico School of Medicine

Arthroscopic

• Survey By AANA in 1998 5% of surgeon perform all arthroscopic RTC repair.
• Percentage increased to 24% in 2003 and 62 % in 2005
• Major improvements in surgical instruments
• Increase in teaching institutions which teach arthroscopic techniques

If we can see the tear and reach it with arthroscopic instruments, we can repair it arthroscopically.
- Stephen Burkhart

If we can see it, reach it, have extra hands, depends on how many cases we have, and if we have enough water in the hospital,  then we can fix the tear arthroscopically.
- Magdiel Mayol (2008)

With proper practice and an educated staff, and patience, most RTC tears can be repaired arthroscopically.
-Magdiel Mayol (2010)

Goals of Treatment

• Full ROM
• Full Strength
• Relief of Pain

Pathology

Impingement

• External: due to narrowing of the supraspinatus outlet with cuff irritation; acromial morphology, AC osteophytes, CA ligament, bursitis

Stage I: reversible; edema and hemorrhage
Stage II: irreversible; tendonitis; may include partial thickness rotator cuff tears
Stage III: significant tendon degeneration and tearing

Spectrum of Disorders

• Impingement/Tendonitis
• Partial Thickness Rotator Cuff Tear (PTRTC): can be articular, intratendinous, or bursal
• Grade 1: fraying
• Grade 2: involves less than 50% of the tendon thickness
• Grade 3: involves greater than 50% of the thickness of the tendon

These tears have an earlier peak incidence than full thickness tears; arthrography has shown that PTRTCs progress to FTRCTs (28%)
Yamanaka, et al.  Clin  .  1994(304):68-73

Spectrum of Disorders

Positioning patient

Beach Chair

Drawing Landmarks

Posterior portal

Lateral and Anterior Portals

Diagnosis Scope

Intraarticular Findings

• SLAP lesions
• Glenohumeral arthritis
  Loose bodies
  Bankart Lesion
  Partial RTC tears
  Biceps tendon tear

Diagnosis Scope videos

Biceps Pathology

• SLAP < 60 y/o = repair
  SLAP > 60 y/o = tenotomy
  Biceps tear < 50% = debridment
  Biceps tear >50%
  • >60 y/o = tenotomy
    <60 y/o tenodesis
    • Soft tissue
      Open to bone
      Arhtoroscopic to bone

SLAP Repair videos

Subacromial

• Release CA Ligament or Not
• Distal clavicle resection
• Acromioplasty
• RTC repair
• Bursectomy

Red Sea

What to do!

• Take a deep breath.
• Control fluid and turbulence

Steps For Better Visualization

• Control blood pressure
• Artroscopic pump pressure
• Rate of fluid flow
• Turbulence within the system
• Make Sure inflow is not blocked
• Have good Suction
• Patient’s blood pressure
• Stop bleeder’s

Stop bleeders

Don't!!!

Patience

Deliniate acromion

CA Release

Acromioplasty

Distal Clavicle Resection

Prepare foot print

Anchor Placement

Suture management

Piercing tendon

Piercing Tendon

Suturing

Single Row

Double Row Suture Bridge

• Medial row anchors at cartilage border at foot print
• Lateral row with anchors pressing on foot print
• Crossing of medial sutures at lateral row completing suture bridge

Preparation

Medial Row

Lateral Row

Preparation

Inserting

Lateral Row

Tensioning

Final product

Post-OP X-Ray

Pearls for Success

• No “Awe Factor”
• Always keep moving
• Suture Management
• Visualization

Treatment - Repair

• Arthroscopic
  • Gartsman reports 90% patient satisfaction
    • Improved ROM
    • Improved strength
    • Decreased pain
    • Improved function
      • Gartsman.  Clin Orthop.  September 2001.

Outcomes

• Size of tear
• Age
• Fatty-degeneration
• Patient’s expection