Background: Symptomatic rotator cuff tears can cause significant pain and functional disturbance, with associated financial ramifications. Non-surgical management should always be considered initially, however if recalcitrant to these measures surgical intervention may involve open, arthroscopic-assisted mini-open or arthroscopic rotator cuff repairs. The use of trans-osseous sutures and suture anchors has been reported with good results, with no significant differences if the repair remains intact or recurrent tears occur. The role of traditional suture anchors has been assessed clinically and biomechanically, however there have been reports of pull out, anchor material found within joint and concerns with the amount of bone loss. The all suture anchor (ASA) is proposed to address these concerns with encouraging cadaveric, biomechanical results to date. Methods: The two senior authors performed 31 arthroscopic rotator cuff repairs using ASA with a double row technique at the two study centres'. The patients were reviewed in clinic at one month, three months, 6 months and a year postoperatively. The patients were assessed with the Constant score and clinical range of motion of the shoulder in abduction, forward flexion, external rotation and internal rotation. The surgical technique and rehabilitation was the same for both surgeons. Results: At a mean follow up of 10.2 months (range 3-12 months) the mean constant score was 77.1 (range 35-90), with a mean abduction of 139.6 (range 30-180), external rotation of 43.4 (range 20-80), and internal rotation to lumbar vertebrae 3-4 (range buttock to lumbar vertebra 1). There has been one rerupture to date. Conclusions: The functional and clinical results in our study are comparable to those reported in literature using standard anchors.

Abstract:We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The proximal end of the guide is approximated to the greater tuberosity at the cuff footprint, and a complete transosseous tunnel is created with a 2.4-mm drill. An all-suture implant is inserted through this tunnel down to the calcar, and its deployment is visualized under arthroscopy. Gentle traction is applied to the anchor, resulting in a 4-mm concertina of the suture anchor that rests opposed to the medial cortex. The major advantage of this technique is the fixation strength gained from the biomechanically superior cortical bone of the calcar. Furthermore, this method permits greater preservation of bone surface area at the level of the footprint for a larger tendon-to-bone healing surface. This technique also provides an excellent alternative in revision situations. R otator cuff pathology is a common problem, with an incidence of 87 per 100,000 person-years. The highest incidence of this pathology is seen in women and in the age group 55 to 59 years.

Background: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck is reported to be the most important step of the Latarjet procedure. Purpose: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures: one surgeon performed all open techniques, and the other performed all arthroscopic techniques, respectively. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis muscle split were evaluated. Results: The mean surgical time was significantly longer in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG (Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.8º for OG and 15.1º for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transverse directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG. The location where the longitudinal subscapularis muscle split was performed was significantly higher in the AG. Conclusion: The open Latarjet technique required less surgical time; presented a lower number of intraoperative complications; and allowed more adequate placement of the CG, better centering of the screws, and a subscapularis muscle split closer to the ideal position. Clinical Relevance: The reported benefits of the arthroscopic Latarjet technique seem less clear if we take into account the added surgery time and complications.

Background: Rotator cuff tears are one of the most common causes of shoulder pain. All-suture anchors are increasingly being used in the arthroscopic repair of rotator cuff tears. The purpose of this experimental study is to evaluate the biomechanical properties of all-suture anchors at different insertion sites in the proximal humerus relevant to rotator cuff repairs and the remplissage procedure. Methods: Sixteen cadaveric shoulders were used for the study. Four all-suture anchors were inserted in each proximal humerus at common anchor insertion sites on the rotator cuff footprint and a simulated Hill-Sachs defect. Cyclic loading and load-to-failure tests were undertaken. The number of cycles, load to failure and nature of failure were recorded. Results: The all-suture anchors placed in the cuff footprint using a transosseous technique displayed superior biomechanical properties. Sutures sited in this way demonstrated a maximum tensile load to failure of 542 N as well as a highest mean load to failure and the maximum number of cycles before anchor failure. In descending order, all-suture anchors placed in the lateral footprint were significantly superior to those located in the medial row and in a simulated Hill-Sachs defect. Discussion: Anchors placed in the rotator cuff footprint exceeded the physiological isometric abduction forces for the supraspinatus and infraspinatus. Data obtained from our study suggest that all-suture anchors are strong enough to be used for the repair of rotator cuff tears.

Irreparable rotator cuff tears (RCTs) cause shoulder pain and disfunction. Management of RCT patients has classically been difficult due to few treatment options. Since Mihata et al. in 2013 introduced the superior capsular reconstruction (SCR) technique as a treatment option, it has become widespread among surgeons, especially for young active patients in whom reverse shoulder arthroplasty is not recommended. With SCR, a reduced humeral head can be maintained and superior displacement is avoided, improving shoulder pain and restoring active shoulder motion. A variety of grafts may be used, but the surgery can be technically complicated. An arthroscopic lasso-loop traction technique for SCR is described here, which simplifies graft shoulder reduction by traction from the anteromedial and posteromedial portals.

Case: A 48-year-old male patient with a type V acromioclavicular injury with a 3-tendon acute cuff tear, anterior glenohumeral dislocation, and an axillary posttraumatic neuropathy is presented. The rotator cuff tear was sutured and an all-arthroscopic–modified coracoclavicular ligaments (CCLs) reconstruction technique was performed with a gracilis tendon graft and a double knotless suture fixation system. Conclusions: An arthroscopic approach allows the surgeon to identify and treat associated glenohumeral lesions in type V acromioclavicular dislocations. In addition, the modified CCL reconstruction technique addresses effectively the AC instability.