Mini-open rotator cuff repair

OVERVIEW

Synopsis

Mini-open rotator cuff repair techniques were evolved to minimize morbidity from open techniques. This technique has been proven to provide reliable clinical improvements in patients with rotator cuff tears; however, it has been largely replaced with all arthroscopy-based procedures. Specific technical points will be given to aid the surgeon in obtaining reliable results.

Important points

Mini-open techniques can also be used in most patients with a rotator cuff tear.
A detailed history, and physical examination, appropriate imaging, and preoperative planning will help indicate patients for surgery.
Treatment may differ in acute versus chronic tears.

Clinical and surgical pearls

Performing expeditious arthroscopy is important to limit soft tissue fluid extravasation.
Adequate bursectomy and limited acromioplasty will aid visualization.
Rotation of the arm will help determine the extent of the tear.
Tendon tear pattern, tendon quality, and tendon mobility are important factors to determine before proceeding with a repair.
Appropriate releases may be required to provide a tension-free repair.

Clinical and surgical pitfalls

Avoid excessive retraction on the deltoid.
Monitor the distal end of the split, and use stay sutures to avoid axillary nerve injury.
Massive cuff tears and subscapularis tears may be difficult to repair owing to visualization, rotation of the arm, and abduction.

Introduction

Rotator cuff surgery is among the most commonly performed orthopedic procedures and is continually evolving. Large open procedures historically have had good clinical results but with the risk of significant morbidity and worsened cosmesis. The increased morbidity related to the detachment of the deltoid from the acromion in open approaches could be functionally disabling. This led to the advent of mini-open and all-arthroscopic techniques that bypass this portion of the procedure. These techniques have lessened the morbidity and have achieved success rates that approach those of open surgery in most studies. Pain relief and restoration of function are the primary goals of rotator cuff repair surgery. Structurally, cuff tendon healing with preservation of functional muscle with minimal atrophy and fatty infiltration is the goal. This chapter will focus on the mini-open technique and outcomes.

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