Arthroscopic rotator cuff repair technique shoulderdoc. Rotator cuff repair depends on both the fixation strength of the chosen repair construct and the local healing response of the repaired tissue. A healed rotator cuff repair results in a superior outcome for the patient compared with a nonhealed repair. Rehabilitation guidelines for type i and type ii rotator cuff. This is an enhanced pdf from the journal of bone and joint surgery. Prior to the development of arthroscopic surgery, all rotator cuff tears were repaired by looking directly at the torn tendon through an incision about 6 to 10 centimeters in length. To perform arthroscopic rotator cuff repair, your doctor will make three small, buttonhole sized incisions in the area around the shoulder. Prospect guideline for rotator cuff repair surgery. This video demonstrates the steps involved in one type of arthroscopic repair.
Mark powell if biceps tenodesis is concomitantly performed, no biceps strengthening until 8 weeks postoperative if approved by physician. Open versus two forms of arthroscopic rotator cuff repair ncbi. Arthroscopic rotator cuff repair physical therapy protocol small tears one anchor phase i. The past decade has seen a major change in the way that rotator cuff surgery is performed. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Arthroscopic rotator cuff repair resume of scott j. Among a growing discussion surrounding the superiority of one surgical technique over another, the surgeons ability to complete a rotator cuff repair with technical acuity in a timely manner remains paramount. Although the rotator cuff can get injured at the muscletendon junction, most commonly a rotator cuff tear involves tendon fiber detachment off of bone. May remove sling for tabletop activities within pain tolerance such as eating, brushing teeth and occasional keyboard use. Jan 01, 2016 rotator cuff injury is a common condition that has been reported to affect more than 40% of the us population over 60 years of age. Three arthroscopic techniques for repairing the rotator cuff. Rotator cuff repair arthroscopic patient education and. Open, miniopen, and allarthroscopic rotator cuff repair.
Aug 07, 2019 the analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non. Arthroscopic rotator cuff repair rehabilitation protocol. Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness. Sling with supporting abduction pillow to be worn at all times except for hygiene and therapeutic exercise codmans pendulum exercise, elbowwristhand rom, grip strengthening. Arthroscopic rotator cuff repair advocate health care. Arthrex offers many anchor and surgical technique options for surgeons who prefer to tie knots. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the american society of shoulder and elbow therapists. Recent advances in arthroscopic rotator cuff repair have resulted in improved outcomes. It is important to remember that time frame for healing of the repair does not change based on the method of repair. Early incorporation of an evidencebased aquaticassisted. Previous authors have presented open and arthroscopic repair techniques that involve recognition of the tear con.
Arthroscopic subacromial decompression for small and. Rotator cuff grasper the rotator cuff grasper features a long shaft and a wide, deep jaw that allows for superior purchase when grasping tissue during rotator cuff surgery. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. There are several different arthroscopic techniques that can be used to repair a torn rotator cuff. Arthroscopic rotator cuff repair with concomitant capsular.
Doublerow ripstop technique for arthroscopic rotator cuff. Arthroscopic rotator cuff repair postoperative guidelines. Arthroscopic rotator cuff repair protocol small to medium sized tears david j. Avi file repair software avi file audio video interleave also audio video interleaved, known by its acronym avi, is a multimedia container format introduced by microsoft in november 1992 as part of its video for windows technology. Allarthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff. Sports medicine arthroscopic surgery the intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. The sr series graspers feature a selfreleasing lock mechanism that is easily disengaged by simply moving the handles apart. Rotator cuff tears are a common cause of shoulder pain and dysfunction in the adult shoulder. Rotator cuff is the term given to describe a group of four tendons that support and stabilize the shoulder joint. Patient to do home exercises given postop p endulums, elbow rom, wrist rom, grip strengthening patient to remain in splint for 6 weeks weeks 16. The advantage of open rotator cuff repairs is the rotator cuff tendons are easily seen by this method. Pdf the purpose of this article is to report the 4 to 10year results of arthroscopic repair of full thickness rotator cuff tears. Advances in mobilization techniques allow rotator cuff repair through use of a single or. The goal of rotator cuff repair is to eliminate pain and improve function with.
The reason for this is both pain and the functional demand of the patient. Specific changes in the program will be made by the physician as appropriate for an individual patient. Arthroscopic massive rotator cuff repair and techniques for. Patients that have a rotator cuff repair performed arthroscopically tend to be less painful postoperatively than the patients that have an open repair.
The rate limiting factor in arthroscopic rotator cuff repair is the biologic healing of the cuff tendon to the humerus, which is thought to be a minimum of 812 weeks. The rotator cuff tendon needs to heal back into the bone. A total of 118 patients between the ages of 18 and 50 years with arthroscopic rc repair will be randomized to 2 treatment arms. Arthroscopic subacromial decompression for small and medium. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non. However, to make an informed decision and give your. Arthroscopic rotator cuff repair general sling and abduction pillow for four weeks, then sling without pillow for two more weeks wear at all times while awake and asleep can remove when sitting and hep no active shoulder abduction, flexion or rotation for six weeks for most repairs phase i. Montgomery et pared the results between arthroscopic decompressions without cuff repair to open repairs of the torn rotator cuff. Sports medicinearthroscopic surgery the intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Repair of the rotator cuff requires reattachment of the rotator cuff tendon back to the humerus. All arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
Some surgeons recommend staging surgical procedures and delaying rotator cuff repair. Arthroscopic rotator cuff repair protocol sequence note. Immediate postoperative days 1 to 10 goals maintain integrity of the repair gradually increase passive range of motion diminish pain and inflammation prevent muscular inhibition days 1 to 6 brace ultrasling with abduction pillow. Arthroscopic rotator cuff repairs use small incisions versus the larger openings required for the conventional rotator cuff repair, makes this a preferred procedure for patients. Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. If you have any questions regarding the progress of the patient, the physician should be contacted. Arthroscopic rotator cuff repair protocol boston shoulder institute. Pdf early reports on arthroscopic massive rotator cuff repair demonstrated acceptable clinical outcomes with low rates of postoperative cuff. Move into available range, painfree and as tolerated at least 0 90.
Independent with adls with modifications while maintaining the integrity of the repair. Small tear arthroscopic rotator cuff repair postoperative guidelines. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. Arthroscopic rotator cuff repair rehabilitation protocol rom immobilizer therapeutic exercise phase 1 04 weeks no prom. The intent of this guideline is to provide both the patient and treating therapist with a framework of the postoperative rehabilitation course following arthroscopic assistedminiopen rotator cuff repair. Immediate postoperative days 1 to 10 goals maintain integrity of the repair gradually increase passive range of motion diminish pain and inflammation prevent muscular inhibition days 1.
This procedure is carried out when a patient has a symptomatic rotator cuff tear. The advantages of repairing a rotator cuff tear arthroscopically keyhole surgery are. Pdf arthroscopic rotator cuff repair using the undersurface. The intent of this protocol is to provide the clinician with a. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Progression of arom against gravity and duration of sling use is predicated both on the size of tear and quality of tissue and should be guided by referring physician. Arthroscopic rotator cuff repair physical therapy protocol. Arthroscopic repair is usually performed as an outpatient procedure and is the least invasive method used to repair a torn rotator cuff. Arthroscopic rotator cuff repair frequently asked questions. Despite advanced mobilization techniques, arthroscopic repair of massive rotator cuff tears is associated with a high retear rate.
This may be performed either through keyhole surgery arthroscopy or open surgery, using sutures and bone anchors. This can be performed in many different ways ranging from open to all arthroscopic procedures and single or double row repair techniques. Arthroscopic repair of the rotator cuff is an increasingly popular method, one for which many authors have reported satisfactory outcomes. Early postoperative outcomes between arthroscopic and mini. Arthroscopic rotator cuff repair guys and st thomas. This technical note presents our preferred technique of an allarthroscopic, medialized repair with.
Anatomic repair of massive cuff tears is also technically difficult due to scarring, retracted tissue. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. It is likely that there has already been an attempt at non surgical treatment such as injections or physiotherapy. Initiate manual resistance er supine in scapular plane light resistance. These tears may be the result of an injury you can read our post on acute rotator cuff tears or wear and degeneration read our post on chronic rotator. Rolf phase i immediate post surgical phase weeks 14. Within the active population, no matter the patients age, an active sporting individual with a traumatic rotator cuff tear is an indication for arthroscopic rotator cuff repair. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial.
Arthroscopic rotator cuff repair florida orthopaedic institute. Left arthroscopic view of a healthy shoulder joint. Current evidence for effectiveness of interventions to treat rotator cuff tears. Right in this image of a rotator cuff tear, a large gap can be seen between the edge of the rotator cuff tendon and the humeral head. Rotator cuff injury is a common condition that has been reported to affect more than 40% of the us population over 60 years of age. Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. Arthroscopic rotator cuff repair rehabilitation protocol dr. The surgeon can maximize the chance of a healed repair by knowing the endpoint of each key step in the repair process and adhering to a few core principles. Our metaanalysis indicated that early motion after arthroscopic rotator cuff repair resulted in a significantly greater recovery of external rotation from preoperation to 3, 6, and 12 months. Effectiveness of supervised early exercise program in. A miniopen repair procedure also uses newer technology and instruments to perform a repair through a small incision. The patients in this study treated with arthroscopic decompression alone had less satisfactory results than those who had repair of the cuff.