Arthroscopic transosseous reinsertion of the rotator cuff

Arthroscopic reinsertion of the supraspinatus and infraspinatus tendons by means of imitation of an open transosseous reinsertion technique.

Tears in the tendon cuffs of the supraspinatus and infraspinatus muscles. Patients < 75 years of age.

Retracted tendons that cannot be sufficiently mobilized to provide a tension-free reinsertion. Tears of the tendon cuff of the subscapsularis muscle.

The free edges of the tendons are sparingly resected. The tendon attachment site on the greater tuberosity is freed of soft tissue and decorticated using an arthroscopic bone burr. A full-radius burr is used to drill insertion sites for the sutures in the tuberosity. A hollow needle is inserted percutaneously to puncture the free edges of the tendon for a single reinsertion suture. The hollow needle is then fed through the greater tuberosity to the lateral portal. The suture is guided through the needle and advanced via a working cannula. If the tear is > 2 cm in width, a mattress suture should be placed via another channel in the bone. This is to provide plane contact of the tendon to the reinsertion site.

Restriction of movement using a shoulder bandage for 6 weeks after the operation.

In the 75 patients treated using a single suture, there was an improvement compared to the related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).