Arthroscopic rotator cuff repair surgery
Continuing pain, significant weakness and loss of function in the shoulder are the reason why a rotator cuff tear needs repairing. The tears can vary in size and some of the tears are massive and are not repairable. In majority of the cases this repair is done by Arthroscopic surgery. Some times the arthroscopy assisted open rotator cuff repair would be undertaken.
Steps of the Surgery
Arthroscopic surgery is performed by three or four tiny stab incisions of less than 1cm in size. A miniature tubular camera is introduced into the shoulder joint and the joint is thoroughly visualized. The tear in the rotator cuff muscle is confirmed and depending on the size of the tear the repair is planned. Often there may be other pathology along with the rotator cuff tear. This could be fraying at the biceps tendon attachment, labial fraying, partial tear of the biceps tendon or subluxation of the biceps tendon. These are dealt with at the same time.
The camera is introduced into the space beneath the acromion bone(part of the shoulder blade bone). The camera in this space (subacromial space) gives much better appreciation of the size of tear, quality of the muscle and also gives a chance to assess whether the tear can be mobilized to fix it back in its original position.
Two or three cannula will be introduced through the skin incisions into the subacromial space. Two will be used as working portal and one will be used portal for application of knots.
Tear Mobilisation and Foot print preparation:
Initial step is to mobilize the torn rotator cuff tear and with the help of a miniature grasper, the torn tendon is pulled to see whether it comes to its original attachment. The attachment site of this muscle is called as footprint in the upper end of the arm bone. This attachment site is freshened first with shaver and then with a burr.
Converting a larger size tear into a smaller size tear:
The shape of the tear may differ; some of them are roughly a shape of U or V or L. The tear may initially need a side-to-side stitch with special instruments that can be reached through these small incisions. The side-to-side stitches converges the margins of the tear convert a large size tear into a small size tear. This is medically called as Marginal convergence.
Fixing the tear to the footprint:
Once it is done, the muscle is attached to the footprint. This is performed by initially drilling a hole in the footprint with a miniature drill. Then an absorbable screw with fibrewires in its end is introduced into the hole. The fibrewires are passed through the cuff muscle with the help of a special suture passer. Then the rotator cuff muscle is pulled to reach the footprint and can be anchored with another absorbable screw.