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Treatment of rotator cuff disease 

Treatment of rotator cuff disease
Chapter:
Treatment of rotator cuff disease
Author(s):

Lennard Funk

and Amol Tambe

DOI:
10.1093/med/9780199550647.003.004003
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date: 20 July 2018

Arthroscopic techniques have revolutionized the surgical management of rotator cuff disease

Arthroscopic subacromial decompression (ASD) is accepted as a well established method for the treatment of symptomatic impingement after conservative treatment has failed

Appropriate patient selection is paramount to a successful outcome

Attention to detail including patient set-up, maintaining optimum fluid pressure and portal placement are essential to achieve successful outcome

Erroneous diagnosis is the commonest cause of failure following ASD

Thorough debridement of the subacromial bursa forms a key element of ASD. Aggressive bony resection with violation of deltoid origin can cause undesirable outcome

Many large studies indicate good to excellent results for ASD in over 85% patients.

Rotator Cuff repair:

Surgery for rotator cuff repair has evolved from open to mini-open to all arthroscopic

Arthroscopic rotator cuff surgery can be challenging as cuff tears present in a variety of shapes and sizes with variable tendon quality

Number of classifications exist for rotator cuff tears but it is important to understand the tear geometry to enable good repair

Traumatic cuff tears in the active population causing functional loss, irrespective of the age of the patient, constitute an indication for rotator cuff repair

Key principles in arthroscopic cuff repair include assessment of the tear, release and tendon mobilisation, secure attachment of the tendon to the prepared footprint and regaining movement and its control

Number of portals are utilised for arthroscopic rotator cuff repair though most can be accomplished by the four portal technique

Direct tendon to bone repair, margin convergence, single row and double row repair are some of the commonly used repair techniques

Arthroscopic surgery has facilitated ‘Accelerated rehabilitation programmes’, which are gradually replacing the more traditional post-operative immobilisation protocols following rotator cuff repair.

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