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Shoulder Arthroscopic Rotator Cuff Repair and Arthroscopic Acromioplasty Operative Example

DESCRIPTION OF OPERATION:  The patient was taken to the operating room and placed on the operating table in the supine position. Interscalene block was given by the anesthesiologist. At this point, general anesthesia was induced by the anesthesiologist. The patient was placed in the beach-chair position. All bony prominences were padded. SCD boots were placed on both legs and cycled throughout the entire surgery. The patient was then placed semi-upright in the beach-chair position. The right shoulder was prepped and draped in the usual sterile fashion. At this point, a standard diagnostic shoulder arthroscopy was performed with standard posterior portal. Following findings were obtained; full thickness anterior rotator cuff tear, minimal degeneration of the anterior labrum. At this point, the scope was placed in the subacromial space. The rotator cuff tear was identified. The repair was conducted using the Arthrex PushLock anchors creating a suture bridge. First, the bursa was debrided with a Mitek VAPR. Then, the rotator cuff was debrided with a 4.0 full radius shaver. The bony wedge was debrided as well with a 4.0 full radius shaver. At this point, two medial articular anchors were then placed through a separate stab wound/incision adjacent to the acromion. These sutures were then passed using the Scorpion suture passer through the medial most portion of the rotator cuff tendon, in a mattress fashion, in each anchor. Once this was done using arthroscopic knot-tying techniques, the rotator cuff was tied down to the two medial anchors. At this point, one suture limb of the anterior anchor and one suture limb of the posterior anchor were placed together and passed through a PushLock anchor placed through the lateral portal further down the lateral aspect of the greater tuberosity. The first anchor was placed posteriorly and then this suture was secured into this knotless anchor. Next, a second PushLock anchor was passed more anterior, taking the other limb from the anterior medial anchor in the anterior limb of the posterior medial anchor, passed through the second PushLock suture and this one was placed and secured anteriorly. This created a crusting suture bridge repair. There was no defect noted after probing with an arthroscopic probe. Next, the shoulder was brought back to the neutral position from the abducted external rotation position and an acromioplasty was performed with a 4.0 barrel bur. The portals were then closed with 4-0 nylon single interrupted sutures, bulky sterile dressing, and a shoulder immobilizer was applied. The patient tolerated the procedure well and was taken to the recovery room in stable condition.

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