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This is a patient with previous pectoralis rupture.
He is an avid weightlifter but he has developed a rotator cuff here secondary to chronic posterior
instability with extension of labrum tearing into the superior quadrant and the anterior
inferior quadrant. Given the compromise of the biceps pulley
and the SLAP lesion, we combine biceps tenodesis with SLAP lesion repair.
Here the subscapularis is incorporated into our soft tissue locking lasso rack hitch tenodesis
technique and a PDS suture is passed around the subscapularis tendon and biceps and it
is traded out for a permanent braided suture. In situ tension of the biceps is set and the
center of the lasso is retrieved utilizing a bird beak and a modified rack hitch, knot
is tied, completing the tenodesis. Then we just release the biceps insertion
to the superior labrum. Next the superior labrum tear is fully mobilized
and starting in the posterior superior quadrant we placed these all suture anchors sequentially
restoring the superior labrum back anatomically. The appropriately curved suture passer is
used to pass the shuttle PDS suture to more accurately determine where the suture is placed
within the tissue. One limb of the anchor suture and the PDS
are retrieved
and tied to provide appropriate physiologic compression so that the labrum can heal back
at its anatomic position. Here we can see the completed SLAP lesion
repair. Here after we have mobilized the inferior
hemisphere labrum so that it can be placed on the glenoid face without any tension replacing
all of the suture anchors at the articular margin and then we will start our capsular
shift and labrum reconstruction at the 6 o'clock position.
We use a combination of simple and horizontal mattress sutures to help restore labral height
and here we are completing the last suture in the posterior inferior quadrant and we can see we have restored a speed bump
or bumper cushion very nicely and the humeral head is nicely recentered back on top of the
glenoid face with the labrum reconstructed in all three zones.
We take the shoulder through range of motion confirming excellent stability and balance
and no motion restriction. Now we are going to move to the subacromial
space to address this rotator cuff tear. He has some undermining and this is a V-shaped
tear but the very medial aspect actually should be restored laterally on the footprint and
it is very important to determine the appropriate patter to restore uniform tension in the entire
musculotendinous junction. For this tear we utilized a single BioComposite anchor placed
beyond the footprint and a single perpendicular transosseous tunnel with two permanent braided
sutures and a rip-stop suture. So you can see we've passed all of our sutures
medial to the rip-stop stitch we placed and here we are getting ready to tie the last
transosseous suture to compress the entire footprint nicely.
Repair strength is really proportional to the number of sutures and we can see we always
attempt to over engineer each repair to help increase the likelihood of successful healing.