Objective: Arthroscopic reinsertion of the supraspinatus and infraspinatus tendons by means of imitation of an open trans osseous reinsertion technique.Indications: Tears in the tendon cuffs of the supraspinatus and infraspinatus muscles. Patients < 75 years of age. Contraindications: Retracted tendons that cannot be sufficiently mobilized to provide a tension-free reinsertion. Tears of the tendon cuff of the subscapsularis muscle. Surgical Technique: The free edges of the tendons are sparingly resected. The tendon attachment site on the greater tuberosity is freed of soft tissue and decorticated using an arthroscopic bone burr. A full-radius burr is used to drill insertion sites for the sutures in the tuberosity. A hollow needle is inserted percutaneously to puncture the free edges of the tendon for a single reinsertion suture. The hollow needle is then fed through the greater tuberosity to the lateral portal. The suture is guided through the needle and advanced via a working cannula. If the tear is > 2 cm in width, a mattress suture should be placed via another channel in the bone. This is to provide plane contact of the tendon to the reinsertion site. Postoperative Management: Restriction of movement using a shoulder bandage for 6 weeks after the operation. Results: In the 75 patients treated using a single suture, there was an improvement compared to the European Journal of Trauma
Continuing Education
The following is a reprint from Operat Orthop Traumatol 2006;18:1-18 and continues the new series of articles at providing continuing education on operative techniques to the European trauma community.related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).The open transosseous suture is still the gold standard in the treatment of ruptures of the rotator cuff. However, in the last few years, the technique of arthroscopic reinsertion of the tendon stump has been standardized and definitely improved. There are various fixation systems for the arthroscopic surgical technique. Until now, it has not been clear whether a dowel or a suture-anchoring technique can provide reconstruction of the anatomy and breaking strength comparable to a transosseous suture [4,8,9]. We therefore developed an arthroscopic transosseous suture
There was no increase in injury risk at the pistes in recent years. The use of protectors has a positive effect and should be supported in the future too.
In the 75 patients treated using a single suture, there was an improvement compared to the related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).
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