♦ 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.
