Left shoulder arthroscopy with arthroscopic cuff repair Subacromial decompression including acromioplasty Debridement of glenohumeral joint, major anterior and posterior labral tissues

PREOPERATIVE DIAGNOSIS:                Left shoulder rotator cuff tear, impingement, labral tear.

POSTOPERATIVE DIAGNOSIS:             Left shoulder rotator cuff tear, impingement labral tear.

OPERATION PERFORMED:                    1. Left shoulder arthroscopy with arthroscopic cuff repair.

2. Subacromial decompression including acromioplasty.

3. Debridement of glenohumeral joint, major anterior and posterior labral tissues.

FINDINGS:                                                    Mild arthritis, left shoulder posteriorly with full-thickness cuff tear and absence of biceps tendon with labral tear anterior and posterior.

ESTIMATED BLOOD LOSS:                    Minimal.

FLUIDS:                                                        Crystalloid.

COMPLICATIONS:                                                 None.

HARDWARE:                                               Bio-SwiveLock 5.5 and a 4.5 Bio-PushLock with #2 FiberWire totaling 8 suture limbs, 4 anterior and 4 posterior.

INDICATIONS FOR SURGERY:              The patient is a 75-year-old woman with a left shoulder rotator cuff tear. Risks, benefits, and alternatives were discussed. The patient wished to proceed with surgery.

PROCEDURE IN DETAIL:                        The patient was identified, brought to the operating room, and placed in the supine position on the table. After induction of general anesthesia, left shoulder was sterilely prepped and draped in the usual fashion. Shoulder was inflated with saline, and portal sites were established. The findings were as follows: The patient was noted to have a tear of the anterior and posterior labrum, full-thickness rotator cuff tear, and acromion to be visualized. The biceps tendon was basically absent. There was some remnant, but there was no good actual biceps tendon that could be visualized. This may have been slightly subluxed. The subscapularis tendon, however, was grossly intact. At this time, we debrided the anterior and posterior labral tissues.  We used cautery for hemostasis.  There were findings of arthritis posteriorly in the humeral head, but the glenoid looked in generally good shape, and the posterior cuff looked to be in good shape as well. At this point, we went in subacromial space. We debrided the subacromial bursa. We performed an acromioplasty using a 4.0 burr. The tear pattern was an L-shaped pattern and was in anterior aspect _____ was retracted anteriorly slightly, as well as well as a posterior leaflet which remained along the supraspinatus border. I felt that one side-to-side suture would help reduce the tear pattern and help and aid in our reduction. We used a clamp to the grasp the cuff and reduce the tear. Initially, we used two Arthrex FiberWire sutures in a modified pattern, creating 2 double limbs. We tied the apex of the tear and then placed additional sutures anterior to the apex of the tear. We then fixed this using the Bio-SwiveLock 5.5 with excellent fixation. However, there was a posterior leaflet that still remained since this somewhat delaminated, and I passed sutures arthroscopically through the posterior leaflet using the Dyonics system using needles and then passed a total of 2 additional sutures posteriorly in a more of a simple pattern, and this created a posterior leaflet which was fixated anteriorly using the Arthrex 4.5 Bio-PushLock which we placed near the bicipital groove region. Once this was done, the cuff was nicely repaired. The wounds were irrigated and closed with simple nylon sutures, and the shoulder was injected with Marcaine for postoperative pain control. The patient tolerated the procedure well. My assistant was essential during this case.