We demonstrate a technique and the preliminary results of arthroscopic rotator cuff repairs performed by means of trans-osseous (bone tunnels) fixation, using newly designed instruments.
We have designed a curved awl and a curved hollowed hook enabling the making of bone tunnel under arthroscopy, and the visual retrograde passage of sutures through it. After testing it on arthroscopic training lab models, we have proceeded to forty (40) consecutive cases of arthroscopic rotator cuff repair (small and medium size tears). We have assessed the patients at 2,4 and 6 months post-operatively.
We have achieved full repair in 38 of the 40 cases. In the two cases we did not succeed, it was due to bone bridge failure during the tying of the knots related to inappropriate distal entry in the humerus (i.e. less than 10 mm distal to the apex of the greater tuberosity). Both were converted to standard repair using suture anchors. Mean operative time was increased for the first 25 cases as compared with our “normal suture anchor time” (+ 11 minutes), but became normal for the last 15. Clinical results at 6 months were comparable to our regular suture anchor experience. Apart from the two cases mentioned above, we report no complications.
Trans-osseous rotator cuff repair can be safely achieved by arthroscopy. The use of reusable specially designed awl and hollowed curved hook facilitate the passage of the sutures under direct visualization. The bone tunnel should include a minimum of 10 mm of lateral humeral cortex for solidity. This technique provides excellent per operative fixation and clinical results that are comparable to those obtained with suture anchors, but at a substantially reduced cost.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.