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Double-row Rotator Cuff Repair: The New Gold Standard
Arthroscopic rotator cuff repair is an increasingly prevalent procedure. Maximizing postoperative outcomes is directly dependent on the integrity of the surgical fixation of tendon-to-bone. Double-row repair utilizes 2 rows of suture anchor fixation of tendon-to-bone: 1 row medially near the articular margin of the humeral head, and a second row laterally near the greater tuberosity. Among the biomechanical and biophysical benefits of double-row repair (as compared with single-row repair) are: a more anatomic footprint reconstruction, decreased strain and increased stiffness across the repair, smaller gap formation and “...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

Techniques in Arthroscopic Rotator Cuff Repair: Single-Row Repair: The Preferred Approach
Several arthroscopic methods of tendon-bone repair have been studied extensively, and controversy remains over the preferred choice of fixation. Single-row constructs, traditionally repaired with anchors placed in a linear manner from anterior to posterior on the greater tuberosity, offer excellent clinical results. To date, sufficient evidence does not exist proving double-row rotator cuff repair will result in superior clinical outcomes to single-row repair, particularly to justify the increased cost and operative time. Multiple systematic reviews have been conducted comparing both double-row and single-row repairs addre...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

The Subscapularis Splitting Technique: Beware the Aberrant Axillary Nerve
We present a case in which the axillary nerve was fortuitously noted to be coursing in an abnormally lateral position anterior to the subscapularis belly exposing the nerve at risk during subscapularis split. Our case clearly represents an important anatomic variant which must be considered when performing the subscapularis splitting approach, as serious and functional deficits will result if the nerve is irrevocably damaged. Beware the aberrant axillary nerve. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - December 1, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

A Novel and Reproducible Anterior Portal for Arthroscopic Distal Clavicle Excision: An Anatomic Description of a New Technique
Acromioclavicular (AC) joint pathology is a common cause of shoulder pain, and arthroscopic distal clavicle resection is a frequently performed procedure for this problem. Here we describe a portal that is directly in line with the AC joint such that the surgeon can easily access the posterosuperior distal clavicle, as this is the region that is most frequently neglected or incompletely resected region with a “standard” or uncontrolled portal. This research provides an anatomic description for creating this anterior portal that preserves local anatomy and is both safe and effective for glenohumeral and AC joint access ...
Source: Techniques in Shoulder and Elbow Surgery - December 1, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Rotator Cuff Repair: Update on Biological Strategies
Biologic augmentation has gained a lot of interest in recent years, as clinicians search for a solution for difficult rotator cuff tears. Platelet rich plasma is compelling as platelets contain several growth factors known to contribute to soft tissue healing. Unfortunately, there is little data to support routine use in the clinical setting. A few studies show there may be a benefit in some larger tears, but results have not been consistent among investigators. Mesenchymal stem cells are undifferentiated cells present in many different tissues. Research investigating the optimal source and delivery mechanism is ongoing, a...
Source: Techniques in Shoulder and Elbow Surgery - December 1, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Brachial Plexus Injuries During Shoulder Arthroplasty: What Causes Them and How to Prevent Them
Neurological complications have been reported to occur in 3% of hemiarthroplasties, 0.1% to 4% of anatomic total shoulder arthroplasties, and 2% to 4% of reverse total shoulder arthroplasties. The brachial plexus is most commonly involved. Observations in cadaver studies have suggested that the most likely etiology of these neuropathies is stretch of the brachial plexus secondary to patient arm positioning. Although the majority of these injuries resolve spontaneously, permanent and debilitating injuries do occur, but rarely. Cadaver and intraoperative nerve monitoring studies have identified shoulder abduction of >90 degr...
Source: Techniques in Shoulder and Elbow Surgery - December 1, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Patient-specific Targeting Guides for Glenoid Component Placement in Shoulder Arthroplasty: Technique and Initial Clinical Experience
Accurate glenoid component positioning is important for successful shoulder arthroplasty. Because traditional instrumentation does not facilitate preparation of the worn glenoid, patient-specific targeting guides have been developed to allow component placement in anatomic version and a desired angle of inclination based on the type of arthroplasty (anatomic or reverse). The purpose of this study is to describe the technique and initial clinical experience of glenoid component implantation with patient-specific targeting guides. Five patients had anatomic total shoulder arthroplasty and 10 patients had reverse total should...
Source: Techniques in Shoulder and Elbow Surgery - December 1, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Humeral Shortening Osteotomy Combined With Reverse Total Shoulder Arthroplasty for Superior Humeral Migration With Acromial Fracture
Fixed superior humeral migration in the setting of a chronic rotator cuff tear is a difficult problem to manage. A reverse total shoulder arthroplasty can restore shoulder function, but the degree of humeral lengthening caused by the procedure places considerable tension on the deltoid and the surrounding neurovascular structures. This can result in neurological compromise, poor joint function, and acromial fracture. The authors present a reverse total shoulder arthroplasty combined with humeral shortening osteotomy. This technique allows independent control of the correction of the joint center of rotation and the tension...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Glenoid Bone Grafting With Reverse Total Shoulder Arthroplasty
We present a case of an elderly patient with glenoid erosion causing a significantly abnormal glenoid version. In this technique, the cut portion of the humeral head was utilized as bone graft. The head was shaped to restore the glenoid version, and the graft was held in place with glenoid insertion techniques. The patient described recovered quickly after the surgery, and she has demonstrated excellent results. These results are similar to those seen by the senior author while utilizing this technique. This is currently our preferred method of addressing glenoid version abnormalities in reverse total shoulder arthroplasty...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

The Subscapularis Splitting Technique: Beware the Aberrant Axillary Nerve
We present a case in which the axillary nerve was fortuitously noted to be coursing in an abnormally lateral position anterior to the subscapularis belly exposing the nerve at risk during subscapularis split. Our case clearly represents an important anatomic variant which must be considered when performing the subscapularis splitting approach, as serious and functional deficits will result if the nerve is irrevocably damaged. Beware the aberrant axillary nerve. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Reverse Shoulder Arthroplasty With Patient-specific Glenoid Implant Positioning Guides
This article describes the use of patient-specific glenoid implant positioning guides in reverse shoulder arthroplasty. After a cadaveric pilot study, reverse shoulder arthroplasty was performed in 7 patients using the patient-specific guides. The patient-specific glenoid implant positioning system provides for preoperative planning on a virtual 3D model of the scapula derived from CT scan images. The accuracy of the patient-specific guides was determined by comparing the postoperative version and inclination of the implant with the preoperatively planned values. The mean native version of the glenoid was 5.2 degrees of re...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

A Novel and Reproducible Anterior Portal for Arthroscopic Distal Clavicle Excision: An Anatomic Description of a New Technique
Acromioclavicular (AC) joint pathology is a common cause of shoulder pain, and arthroscopic distal clavicle resection is a frequently performed procedure for this problem. Here we describe a portal that is directly in line with the AC joint such that the surgeon can easily access the posterosuperior distal clavicle, as this is the region that is most frequently neglected or incompletely resected region with a “standard” or uncontrolled portal. This research provides an anatomic description for creating this anterior portal that preserves local anatomy and is both safe and effective for glenohumeral and AC joint access ...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Rotator Cuff Repair: Update on Biological Strategies
Biologic augmentation has gained a lot of interest in recent years, as clinicians search for a solution for difficult rotator cuff tears. Platelet rich plasma is compelling as platelets contain several growth factors known to contribute to soft tissue healing. Unfortunately, there is little data to support routine use in the clinical setting. A few studies show there may be a benefit in some larger tears, but results have not been consistent among investigators. Mesenchymal stem cells are undifferentiated cells present in many different tissues. Research investigating the optimal source and delivery mechanism is ongoing, a...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Brachial Plexus Injuries During Shoulder Arthroplasty: What Causes Them and How to Prevent Them
Neurological complications have been reported to occur in 3% of hemiarthroplasties, 0.1% to 4% of anatomic total shoulder arthroplasties, and 2% to 4% of reverse total shoulder arthroplasties. The brachial plexus is most commonly involved. Observations in cadaver studies have suggested that the most likely etiology of these neuropathies is stretch of the brachial plexus secondary to patient arm positioning. Although the majority of these injuries resolve spontaneously, permanent and debilitating injuries do occur, but rarely. Cadaver and intraoperative nerve monitoring studies have identified shoulder abduction of >90 degr...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research

Patient-specific Targeting Guides for Glenoid Component Placement in Shoulder Arthroplasty: Technique and Initial Clinical Experience
Accurate glenoid component positioning is important for successful shoulder arthroplasty. Because traditional instrumentation does not facilitate preparation of the worn glenoid, patient-specific targeting guides have been developed to allow component placement in anatomic version and a desired angle of inclination based on the type of arthroplasty (anatomic or reverse). The purpose of this study is to describe the technique and initial clinical experience of glenoid component implantation with patient-specific targeting guides. Five patients had anatomic total shoulder arthroplasty and 10 patients had reverse total should...
Source: Techniques in Shoulder and Elbow Surgery - November 11, 2014 Category: Orthopaedics Tags: Techniques Source Type: research