Arthroscopic Single-Row Rotator Cuff Repair

Sterile Instruments/Equipment

• Standard 30-degree arthroscope

• Self-passing suture passing instrument

• No. 2 braided nonabsorbable sutures

• 4.75-mm self-punching BioComposite suture anchors (Arthrex, Naples, FL).

Positioning

• The patient is positioned in the beach-chair position. Lateral decubitus positioning also can be used depending on surgeon preference.¹

• Care is taken to keep cervical spine alignment in neutral and to protect the ulnar nerve of the nonoperative extremity.

• Before preparing and draping, the subacromial space is injected with local anesthetic mixed with epinephrine. This provides improved hemostasis during subacromial bursectomy, which is critical for optimal visualization during rotator cuff repair.

• The operative extremity is draped free and placed into an articulating arm holder.

Surgical Approach

Portal Placement and Diagnostic Arthroscopy

• Bony landmarks are identified and marked to allow accurate portal placement.

• The posterior portal is positioned ˜2 cm inferior to the scapular spine in line with the posterolateral corner of the acromion (Fig. 13-1).

• The posterior portal, positioned slightly more lateral than the traditional soft-spot portal, allows improved viewing of the greater tuberosity and rotator cuff tear.

• A lateral working portal is positioned ˜2 to 3 cm distal to the lateral border of the acromion. This portal is created with spinal needle localization and is placed at the center of the tear (Fig. 13-2).

• An additional posterolateral working portal can be made in the case of larger tears that necessitate more working space.

• Care is taken to ensure that the lateral portals are placed in an inferior position in relation to the lateral border of the acromion. This serves two important purposes.

• Low portal placement allows instruments to be passed parallel to the rotator cuff during repair.

• The portals also tend to migrate superiorly relative to the rotator cuff as swelling occurs during arthroscopic shoulder surgery.

• The anterior portal is located ˜2 cm inferomedial to the anterolateral corner of the acromion and lateral to the coracoid (Fig. 13-3).²