Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Graft augmentation of rotator cuff repair

OVERVIEW Chapter synopsis Advances in biologic and structural augmentation of full-thickness rotator cuff tear repairs will be necessary to solve the problem of non-healing of large and/or revision tears. This chapter will outline a technique for biologically and structurally augmenting rotator cuff repairs using a human dermal allograft. While many different types of augmentation are currently being investigated, the specific technique described in this chapter has…

Bridging reconstruction for massive rotator cuff tears

OVERVIEW Chapter synopsis Management of massive irreparable rotator cuff tears is challenging, and bridging reconstruction of the rotator cuff with acellular human dermal matrix allograft is a viable solution with good short-term to medium-term results being reported in the literature. In this chapter, we will review the surgical technique for arthroscopic bridging reconstruction of a rotator cuff tear. Important points Proper patient selection is important for…

Arthroscopic management of massive rotator cuff tears: Superior capsule reconstruction

OVERVIEW Chapter synopsis The goal of this chapter is to discuss the indications, operative technique, and rehabilitation protocol for arthroscopic superior capsular reconstruction (SCR) using an acellular dermal allograft Important points Arthroscopic SCR provides significant pain relief and improvement in functional outcomes in appropriately selected patients Arthroscopic SCR with an acellular dermal allograft is safe and effective using the described technique Clinical/surgical pearls A thorough subacromial…

Tendon transfers for rotator cuff insufficiency

OVERVIEW Chapter synopsis Rotator cuff insufficiency resulting from large, chronic rotator cuff tears (RCT) can lead to shoulder pain, weakness, and loss of range of motion (ROM). Tendon transfers are a potential treatment option for irreparable posterior-superior rotator cuff insufficiency. The two most commonly transferred tendons for this pathology are the latissimus dorsi and the lower trapezius. Although the latissimus dorsi tendon transfer (LDT) has a…

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…

Arthroscopic subscapularis repair

OVERVIEW Chapter synopsis Arthroscopic subscapularis repairs are becoming more common, and outcomes are similar to those of open repairs. Many times, the tear is an upper border injury that can easily be addressed with arthroscopic techniques. This chapter outlines the preoperative assessment, technique, and outcomes of arthroscopic subscapularis repairs. Important points Patients often are seen after a traumatic event with internal rotation weakness and pain. Physical…

Arthroscopic rotator cuff repair: Double-row and transosseous equivalent techniques

OVERVIEW Chapter synopsis Double-row and transosseous equivalent repair techniques provide improved footprint coverage, pressurized contact area, reduced motion at the footprint tendon-bone interface, and greater load to failure. It is believed that improved contact characteristics will help maximize the healing potential between repaired tendons and the greater tuberosity. Important points While double-row rotator cuff repair may improve healing biology and biomechanics, TOE techniques optimize healing biology…

Arthroscopic rotator cuff repair: Single-row technique

OVERVIEW Chapter synopsis Arthroscopic repair of the rotator cuff with a single row of suture anchor fixation represents a well-established technique with a high rate of success. Single-row arthroscopic rotator cuff repair can be executed consistently and effectively with relative ease. As with any technique—open or arthroscopic—proper tear pattern recognition and mobilization are essential elements to an appropriate repair. Advantages over more recent double-row techniques include…

Treatment of combined bone defects of the humeral head and glenoid: Combined arthroscopic and open technique

OVERVIEW Chapter synopsis Traumatic anterior dislocation of the glenohumeral joint is frequently associated with osseous injury, including glenoid bone loss and impaction fractures of the posterosuperior humeral head (Hill-Sachs lesion). Recognition of osseous defects is critical to preserve the balance of static and dynamic forces that maintain shoulder stability. Failure to recognize and adequately treat bone loss can lead to recurrent instability and poor clinical outcomes.…

Treatment of recurrent anterior inferior instability associated with glenoid bone loss: Iliac crest

OVERVIEW Chapter synopsis The J-bone graft procedure is indicated in patients suffering from anterior shoulder instability and critical glenoid bone loss. An autologous iliac crest bone graft is shaped to resemble the letter “J” and is press-fit impacted into a scapula neck osteotomy, thus allowing for implant-free anatomic glenoid reconstruction. Important points Indications: Anterior shoulder instability with critical glenoid bone loss Contraindications: Untreated neuromuscular pathologies (e.g.,…

Treatment of recurrent anterior shoulder instability associated with glenoid bone loss: Distal tibial allograft

OVERVIEW Chapter synopsis Glenoid bone loss is frequently present in patients with recurrent anterior shoulder instability. Key factors indicative of significant glenoid bone loss of more than 20% are instability at midranges of abduction (20–60 degrees) and progressive ease of subluxation with daily activities. Young, highly active patients, especially contact or overhead athletes, should be considered for glenoid bony augmentation to restore glenoid surface area, articular…

Arthroscopic latarjet procedure

OVERVIEW Chapter synopsis Bipolar bone loss or failure of Bankart repair has led many surgeons to perform a Latarjet procedure for recurrent instability. Open Latarjet repair has shown good long-term results. The arthroscopic Latarjet procedure combines the advantages of an open Latarjet procedure with the advantages of an arthroscopic approach. Important points Indications include shoulder instability with bone loss of the glenoid, humerus, or both, complex…

Coracoid transfer: The open latarjet procedure for the treatment of recurrent anterior inferior glenohumeral instability in patients with bone deficiency

OVERVIEW Chapter synopsis The majority of anterior instability cases requiring surgery can be successfully managed with arthroscopic soft tissue repair or reconstruction. In the setting of significant bone defects, however, recurrence is high with isolated arthroscopic Bankart repair. The Latarjet procedure reduces recurrence in such cases; however, the procedure is technically demanding and carries the potential for serious complications. Important points Recognizing bone defects in anterior…

Managing bone loss on the humeral head

OVERVIEW Chapter synopsis The glenoid track concept is useful in evaluating the risk of engagement between a Hill-Sachs lesion and the glenoid. There are direct and/or indirect methods of surgical treatment. The direct method includes (1) filling of the humeral head defect by the soft tissues (remplissage procedure), (2) filling of the humeral head defect by a bone graft (iliac crest, allograft), and (3) transhumeral elevation…

Arthroscopic remplissage for management of engaging and deep hill-sachs lesions

OVERVIEW Chapter synopsis Arthroscopic Hill-Sachs remplissage (AHSR) is indicated for patients who are at high risk for recurrence or failure after isolated arthroscopic anterior soft tissue repair, and in whom large humeral head defects are contributing significantly to the instability complex. Important points Indications: Anterior shoulder instability with associated large Hill-Sachs defects as visualized on preoperative plain radiographs, computed tomography (CT) scanning, or magnetic resonance imaging…

Open repair of multidirectional shoulder instability

OVERVIEW Chapter synopsis Multidirectional instability (MDI) of the shoulder is a typically atraumatic condition resulting in the ability to dislocate or subluxate the glenohumeral joint anteriorly, posteriorly, and inferiorly. Patients with atraumatic MDI generally have pathologic laxity contributing to their instability. Treatment is initially conservative. This chapter describes the classic surgical treatment for this problem—the open inferior capsular shift. Important points Operative treatment is reserved for…

Open repair of posterior shoulder instability

OVERVIEW Chapter synopsis This chapter describes the background, etiology, diagnosis, treatment, rehabilitation, and outcomes for posterior instability of the glenohumeral joint treated with open surgical repair. Important points Differentiate from other shoulder pathology using exam and imaging Open procedure best suited for revisions, poor capsular tissue, and significant osseous insufficiency Clinical and surgical pearls Can be performed in lateral or beach chair positions Perform any supplemental…

Open repair for anterior shoulder instability

OVERVIEW Chapter synopsis While arthroscopic shoulder stabilization techniques have become increasingly popular, their popularity is tempered by high failure rates in high-risk groups. Open capsular repair is an often-neglected technique for patients at risk for postoperative instability with success rates comparable to bony augmentation procedures and a low complication rate. Important points Open capsular repair continues to have an important place in the armamentarium of the…

Arthroscopic techniques to manage multidirectional instability of the shoulder

OVERVIEW Chapter synopsis Multidirectional instability (MDI) is a complex condition that involves symptomatic subluxations or dislocations of the glenohumeral joint in two or more directions. A thorough clinical history and detailed physical examination are necessary for proper diagnosis, while a comprehensive understanding of the glenohumeral anatomy and joint biomechanics is critical for successful management. Magnetic resonance imaging (MRI) is the gold standard imaging modality when it…

Arthroscopic repair of posterior shoulder instability

OVERVIEW Chapter synopsis Although increasingly recognized, posterior shoulder instability is relatively uncommon when compared with anterior shoulder instability. A thorough history and physical examination are imperative, with most patients having no specific traumatic event but rather repetitive microtrauma being the cause of pathology. Pain is typically the main symptom. If nonoperative treatment fails, arthroscopic posterior capsulolabral repair has been shown to result in excellent outcomes and…