Rotator Cuff Foot Print - Consideration for Repair

Discussion: (see rotator cuff repair menu)
   - AP dimension is about 25 mm and the medial-lateral dimension is 14 mm;
   - the more that a repair covers and secures tendon over the healing zone, the greater the chance for tendon-bone healing;
   - anatomy:
           - The insertional footprint of the rotator cuff: an anatomic study
           - Humeral Insertion of the Supraspinatus and Infraspinatus. New anatomical findings regarding the footprint of the rotator cuff
           - Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique.

   - biologic preparation of the footprint:
           - references:
                      - Multiple Channeling Improves the Structural Integrity of Rotator Cuff Repair
                      - The effect of multiple channeling on the structural integrity of repaired rotator cuff.  
                      - Rotator cuff repair augmented with endogenous fibrin clot.
                      - Microfractures at the rotator cuff footprint: a randomised controlled study
                      - Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: a prospective randomized study 
                      - Does Footprint Preparation Influence Tendon-to-Bone Healing After Rotator Cuff Repair in an Animal Model?
                      - Microfracture of greater tuberosity speeds healing of rotator cuff tears
                      - Suture Anchor Biomechanics After Rotator Cuff Footprint Decortication
                      - Editorial Commentary: Save the Subchondral Bone in Rotator Cuff Repair Greater Tuberosity Preparation

- Medialization of the supraspinatus tendon: 
         - indicated for situations in which the rotator cuff cannot be adequately mobilized; 
         - instead of reattachement of the cuff to greater tuberosity, the cuff is re-attached to a groove created on anatomic neck or on
                   humeral head; 
         - as noted by Liu J,et al (1998), about 1 cm of medialization may be acceptable but 17 mm of  supraspinatus medialization will
                   result in a significant reduction in the moment arm; 
         - ref: Biomechanical Effect of Medial Advancement of the Supraspinatus Tendon.  A study in cadavera.  
 
- Mobilization of Rotator Cuff: 
        - 
convergence repair 
        - 
ref: Modified margin convergence technique using suture anchors for footprint reconstruction of rotator cuff tears. 

 - Rotator Cuff Repair Techniques:
        - direction and positioning of anchors

References:

Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage.

The influence of medial reattachment of the torn cuff tendon for retracted rotator cuff tears.

Arthroscopic rotator cuff repair failure resulting from decortication of the rotator cuff footprint: a case report.

Tendon-healing to cortical bone compared with healing to a cancellous trough. A biomechanical and histological evaluation in goats



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, June 28, 2016 10:42 am