DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent left rotator cuff tear.
POSTOPERATIVE DIAGNOSIS: Recurrent left rotator cuff tear.
OPERATION PERFORMED: Arthroscopic subacromial decompression with open rotator cuff repair.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 50 mL.
INDICATIONS FOR OPERATION: The patient is an (XX)-year-old male who has had a history of two previous surgeries on the left shoulder that were for rotator cuff tear. He has had diagnosis of another rotator cuff tear by arthrography and MRI and was referred for operative repair.
DESCRIPTION OF OPERATION: The patient was placed in the supine position. After adequate general anesthetic, he was positioned usually on the OR table. The head was secured in the helmet, and he was then positioned in the beach-chair position with adequate padding of his bony prominences. Next, the shoulder and left arm were prepped and draped in a sterile fashion.
We started first by doing an arthroscopy. He had incisions and scars from previous arthroscopy. We went through the posterior scar just below the scapular spine and inserted the arthroscope into the joint without difficulty. The joint was inspected. He was noted to have a fair amount of synovitis within the joint, that we debrided through a separate anterior portal. Once this was cleaned up, we did locate the tear in the rotator cuff that was superiorly in the supraspinatus. It was 1 cm or so away from the actual insertion of the supraspinatus into the greater tuberosity. Multiple Ethibond-type sutures were noted in and around the area of the tear. Otherwise, the articular surfaces of the joint looked to be in good condition. However, we were never able to locate the biceps tendon, so feel that this may have ruptured in the past.
After the joint was debrided, we then transferred the scope to the subacromial space, and due to fair amount of debridement of the scar tissue and bursa tissue within the subacromial space, we did not take down any of the acromion. We were able to visualize the cuff tear from above and just felt it was going to be too difficult to try to repair the intrasubstance tear through the scope, so we removed the scope and then converted it to an open procedure. The patient previously had a superior scar over the lateral edge of the acromion that was utilized. Skin flaps raised and we incised the deltoid right off the anterolateral corner of the acromion, again marked by previous sutures. We came down upon the rotator cuff tear that was easily visualized. The intrasubstance tear was somewhat longitudinally oriented. The cuff tear itself was about 2 cm in diameter. At the edges of cuff and at its insertion just distal to this area of tear, the cuff was seen to be somewhat thinned, so we elected to take down a small portion of it permanently, about 1 cm or so of the cuff in this area debrided back to healthier tissue. Next, a 5 mm twin fixed bone anchor placed into the greater tuberosity at 45 degrees dead man’s angle. The #2 Ethibond sutures were used to repair the edge of cuff back down to the greater tuberosity. We did do some decortication prior to placement of the anchor. The suture anchor tied it down very nicely.
Next, the intrasubstance tear was closed with #2 TiCron, interrupted sutures, in a side-to-side fashion after adequate debridement of the edges. We felt a nice repair was obtained and the wound irrigated out well. We closed the deltoid with interrupted 0 Vicryl. We did take down a small portion of the anterior deltoid off of the acromion and reattached it through the bone holes to the acromion with #2 TiCron. The subcutaneous was closed with 3-0 Vicryl and staples used on the skin. Adaptic, dry sterile dressing applied. The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition.
