Rotator Cuff Surgery- set up is critical.

Rotator cuff problems are common. In general orthopaedics, you will see a lot.

They don’t all have to goto a shoulder surgeon as the technology

has improved so much that the surgery has become a lot easier.
Arthroscopic techniques are available but harder & slower; I prefer a mini
incision technique.
Here are my tips:
• Beach chair (barber chair) position
• Position drapes with pocket drape to hold the arm for you
• Use a small angled retractor (cerebellar retractor;My Kingdom for a good
retractor!)
• Use fibre wire(FiberWire.Taper.Arthrex.AR-7200) for the repair and use
Mitek bony anchors (my preference)
• I use a mini-incision( approx. 2cm), long., over lateral acromion, but do NOT
detach deltoid from acromion, but split deltoid, and then rasp undersurface of
acromion to create enough space for repaired rotator cuff to move in.

Arm rests in bag. Instrument tray on other side of OR

table within easy reach of surgeon

2 to 4 cm mini-incision Large tear, needs FiberWire and bony

anchors
other notes/miscell:

Deltoid (gap/puckering of skin)partially detached in heavy smoker( with soft

bone), at fall 3 weeks after surgery( attacked by bird)

Case 2:

Rotator cuff arthropathy. 71 yo,F. Ultra sound shows large tear- repairable.
Would you repair the cuff or replace the joint?

Case 3:

“Bald head”. Massive cuff tear. Mini incision technique.

60 yo,M.
Repaired via mini incision technique.
Fiberwire. Bony anchors.

\
Major repair at 2 mths in 60 yo,F.

Case 4:

Rotator cuff arthropathy. Good ROM and little pain. 80 yo,F.

Major repair at 2 mths

Case 5:

Massive retracted tear. 70 yo,F. Mobilized and repaired with FiberWire and
Mitek.