Rotator Cuff Tears: Arthroscopic Repair of a Large Supraspinatus Rotator Cuff Tendon Tear

Rotator Cuff Tears: Arthroscopic Repair of a Large Supraspinatus Rotator Cuff Tendon Tear

This video is a cadaveric demonstration of a rotator cuff repair. More specifically, a repair of the supraspinatus tendon, which is the most commonly torn rotator cuff tendon. Let us get oriented. Here, we see a right shoulder in the lateral decubitus position, meaning the patient would be lying on their left side with the right shoulder facing up to the ceiling. The front side of the shoulder is to the left of the screen, and the back of the shoulder is to the right. We see the camera or arthroscope is in the back of the shoulder.

In this video, the surgeon has already placed one soft body anchor, and he is now going to introduce the second. As we cut away to look at the camera view, you can see how the anchor has sharp tips. This allows the surgeon to find the desired position on the bone and hammer in the anchor without preparing a hole with a separate instrument. This helps save time in the operating room. With the anchor in place, the anchor inserter is then removed, and the anchor is secured within the bone. This step is repeated once more, so we will have three anchors in total. Some surgeons prefer to use hard body anchors at this location instead.

As an example, here we have another shoulder, still a right shoulder. We see a metal punch brought into the shoulder joint to prepare a hole for the hard-bodied anchor. After the hole is created, the anchor is brought into the shoulder and secured into the bone. The inserter is then removed. Whichever type of anchor a surgeon chooses to use here, the steps throughout the rest of the procedure remain the same.

Now that we have placed our anchors with sutures, the surgeon will need to pass them through the torn tendon. The surgeon will now grab the sutures from one anchor and bring them outside of the body. These sutures are joined together into one tail. They will load this tail into a suture-passing device, bring the device into the shoulder, and pass the suture through the tendon in just one step. This step is then repeated for the rest of the anchors.

Back outside of the shoulder, now that all the sutures from each anchor have been passed through the rotator cuff tissue, the joint tails can be cut. This gives the surgeon six separate suture strands to complete the repair. Next, one suture from each anchor is retrieved out of the shoulder and loaded into a hard body anchor. Then, a hole is prepared on the outside of the upper arm to allow for the hard body anchor to be inserted. The anchor with the three sutures loaded is brought into the shoulder, and the sutures are tensioned to allow for a good repair of the rotator cuff.

Once appropriate tension is applied, the anchor is brought into the prepared hole and secured into the bone. This step is repeated for the second anchor. The suture limbs are cut and the repair is now complete.