All Arthroscopic Path Augementation of a Massive Rotator Cuff Tear Surgical Technique

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1、All-ArthroscopicPatchAugmentationofaMassiveRotatorCuffTear:SurgicalTechniquePeterN.Chalmers,M.D.,RachelM.Frank,M.D.,AnilK.Gupta,M.D.,M.B.A.,AdamB.Yanke,M.D.,ScottW.Trenhaile,M.D.,AnthonyA.Romeo,M.D.,BernardR.Bach,Jr.,M.D.,andNikhilN.Verma,M.D.Abstract:Surgic

2、almanagementofmassiverotatorcufftearsremainschallenging,withfailureratesrangingfrom20%to90%.Multipledifferentarthroscopicandopentechniqueshavebeendescribed,butthereisnocurrentgoldstandard.Failureafterrotatorcuffrepairistypicallymultifactorial;however,failure

3、oftendon-footprinthealingisoftenimplicated.Patchaugmentationhasbeendescribedasapossibletechniquetoaugmentthebiologyofrotatorcuffrepairinsituationsofcompromisedtendonqualityandhasshownpromisingshort-termresults.Thepurposeofthisarticleistodescribeourpreferreds

4、urgicaltechniqueforarthroscopicrotatorcuffrepairwithpatchaugmentation.Surgicalmanagementofmassiverotatorcufftearsbeendescribedasatechniquetoaugmentthebiologyremainschallenging,andfailureoccursin20%toofrotatorcuffrepair(RCR),withpromisingshort-1,23-590%ofpati

5、ents.Multiplesurgicaltechniqueshavetermresults.beendescribed;thereisnocurrentgoldstandard.ArthroscopicRCRwithpatchaugmentationisbestTreatmentoptionsincludedebridementwithpossibleusedinsituationsinvolvingpoortissuequalitywithbicepstenotomy/tenodesis,partialre

6、pair,muscletransfer,massiverotatorcufftears,tearsof2ormoretendons,tissueinterposition,andrepairwithpatchaugmentation.andfailedprimaryrepairand/orrevisionrotatorcuffOtherpotentialsolutionsincludehemiarthroplastyandsurgery(Table1).Thepurposeofthisarticleistopr

7、ovidereversetotalshoulderarthroplasty;however,theseourpreferredsurgicaltechniqueforarthroscopicRCRsolutionsarenotidealforyoungpatientswithminimalwithpatchaugmentation.Wepostulatethatthisglenohumeralarticulardisease.Patchaugmentationhasstepwiseapproach(Table2

8、)dwhichinvolvescarefullyselectedportalplacementdfacilitateseaseofsuturepassage,organization,andpatchfixationwhileFromtheDepartmentofOrthopaedicSurgery,RushUniversityMedicalavoidingthemorbidityofa