FULL-THICKNESS TEARS: Mini-Open Repair

https://doi.org/10.1016/S0030-5898(05)70277-7Get rights and content

Section snippets

PATIENT SELECTION

The arthroscopically assisted technique of rotator cuff repair is usually reserved for patients with small- to medium-sized tears (i.e., less than 3 cm) without significant retraction. Such tears usually involve the supraspinatus tendon alone or the supraspinatus with extension of the tear into the infraspinatus. Larger tears or those with more extensive retraction can be treated with this technique but are more easily and predictably treated with standard open techniques of rotator cuff repair

TECHNIQUE

The procedure is performed with the patient under interscalene block regional anesthesia using bupivacaine for effective intraoperative and early postoperative analgesia.5 The patient is placed in the semisitting or beachchair position with the back of the operating table elevated 70 degrees. The scapula is stabilized with several folded towels, and the shoulder is positioned laterally enough to prevent abutment of the arthroscope against the edge of the table during the procedure. The bony

RESULTS

The results of arthroscopically assisted rotator cuff repair reported to date have been good. Before the advent of mini-open repair, several investigators reported mixed results after arthroscopic subacromial decompression alone in the presence of a full-thickness rotatorcuff tear.9, 11, 18, 28 Ellman and co-workers9 reported 90% good results with subacromial decompression alone for small tears but only 50% good results if the tear was larger than 2 cm. Gartsman11 reported 50% satisfactory

SUMMARY

Arthroscopically assisted rotator cuff repair through a mini-open deltoid-splitting approach has proved to be an effective means of treatment for small- to medium-sized full-thickness tears of the rotator cuff. It combines the benefits of arthroscopic subacromial decompression, chiefly, relative sparing of the deltoid, with the benefits of rotator cuff repair, especially, more predictable pain relief and the restoration of function that repair offers over debridement alone. The authors have

First page preview

First page preview
Click to open first page preview

References (28)

  • C.L. Baker et al.

    Comparison of open and arthroscopically assisted rotator cuff repairs

    Am J Sports Med

    (1995)
  • W.R. Beach et al.

    Arthroscopic management of rotator cuff disease

    Orthopedics

    (1993)
  • R.H. Cofield

    Rotator cuff disease of the shoulder

    J Bone Joint Surg

    (1985)
  • R.H. Cofield et al.

    Surgical repair of chronic rotator cuff tears

    Orthop Trans

    (1990)
  • Cited by (42)

    • Increased Risk of Surgical-Site Infection and Need for Manipulation Under Anesthesia for Those Who Undergo Open Versus Arthroscopic Rotator Cuff Repair

      2022, Arthroscopy, Sports Medicine, and Rehabilitation
      Citation Excerpt :

      One hypothesis for the increased rates of MUA in the open cohort relative to arthroscopic cohort is that the greater invasiveness of open surgery mediates scar tissue formation that manifests clinically as joint stiffness. Anatomically, the more invasive nature of mini-open approaches requires separation of deltoid fibers extending into the subdeltoid bursa, increasing the possibility of developing postoperative subdeltoid adhesions and subsequent joint stiffness.28-31 In a retrospective study of 64 RCRs performed with an average of 45 months of follow-up, Severud et al.32 reported that 0% (0/35) of patients in the all-arthroscopic cohort developed fibrous ankylosis, compared with 14% (4/29) in the mini-open cohort.

    • Arthroscopic versus mini-open rotator cuff repair: An up-to-date meta-analysis of randomized controlled trials

      2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
      Citation Excerpt :

      For mini-open repair, its relatively limited visualization might not allow optimal access to the rotator cuff and can compromise the effect of surgical releases, perhaps resulting in less optimal repair.34 Furthermore, splitting the deltoid and surgical retraction might account for the increased rate of postoperative arthrofibrosis, which may lead to reduced abduction and external rotation strength for mini-open repair.35 Both mini-open and arthroscopic approaches to rotator cuff repair have been confirmed to achieve satisfactory outcomes by a large number of clinical trials, whereas each technique has its advantages and disadvantages.

    • Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: A 3-5 year follow-up study

      2011, Journal of Shoulder and Elbow Surgery
      Citation Excerpt :

      However, a structurally intact cuff or even a “small” re-tear were related with a superior clinical outcome. Favorable mid- and long-term clinical outcomes have been reported by a number of authors, using a combination of arthroscopic acromioplasty and mini-open rotator cuff repair.27,29,30 Excellent or good clinical results, significant improvement of the quality of life, and patient satisfaction rates as high as 94% have established the above technique as the “gold standard” for the management of rotator cuff tears for a number of years.

    • Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks

      2005, Arthroscopy - Journal of Arthroscopic and Related Surgery
    • Arthroscopic versus mini-open rotator cuff repair: A cohort comparison study

      2005, Arthroscopy - Journal of Arthroscopic and Related Surgery
    • Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters

      2003, Journal of Shoulder and Elbow Surgery
      Citation Excerpt :

      Patients with excessive tendon retraction are supposed to be poor candidates for entirely arthroscopic repair12 or arthroscopically assisted mini-open repair.10,11,25 Pollock and Flatow20 proposed a limit of 2 cm of retraction for arthroscopically assisted mini-open repair, whereas standard open procedures should be chosen for tears with a retraction of 5 cm.10,20 Massive retraction is considered to be a potential limit to standard tendon-to-bone repair.9

    View all citing articles on Scopus

    Address reprint requests to Roger G. Pollock, MD, 161 Ft. Washington Avenue, New York, NY 10032

    *

    From the Department of Orthopaedic Surgery, The Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

    View full text