S sc repair final

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The document describes the steps for performing a subscapularis repair surgery. It begins with positioning the patient in lateral decubitus and establishing arthroscopic portals. It then details classifying subscapularis tears, mobilizing the torn tendon, preparing the footprint with debridement, inserting anchors and sutures, and tying knots to reattach the tendon. Proper management of sutures and evaluation of the final repair are emphasized.

Health & Medicine

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
How to do a subscapularis
repair
Manos Antonogiannakis
Orthopaedic Surgeon
Director of 3rd Orthopaedic Department
Centre for Arthroscopy & Shoulder Surgery
Hygeia General Hospital
ESSKA Advanced Shoulder Arthroscopy Course
All About Rotator Cuff & Other Subacromial Disorders
Verona, 13-14 June 2017 .

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Lateral decubitus
My preferred position
Positioning the patient

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
• Dorsal portal
• Anteroinferior portal
• Anterosuperior portal
 30° or 70° arthroscope

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Classification of SSC-tears (Fox and Romeo)
Type I Partial thickness tear
Type II Complete tear of the upper 25% of the tendon
Type III Complete tear of the upper 50% of the tendon
Type IV Complete rupture of the tendon

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Instability or tear of LBT : tenotomy
or tenodesis
Repair of SSC
then

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Burkhart Stephen
Posterior level push

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Posterior lever
push

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E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
 look for the ‘comma-sign‘

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Coracoid Impingement
Roller-wringer effect
 Normal coracohumeral space: 8-10mm
Burkart St. Cowboy´s guide to advanced shoulder arthroscopy

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair - tear

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
The coma sign

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E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair – tear the coma sign (another example)

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E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Opening the rot interval –preparing the space

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E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Marking with a suture the superior edge of the subscapularis

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Mobilization of SSC tendon
• anterior (open the rotator
interval, free from coracoid
process )
• posterior (from glenoid neck)
• Superior from coracoid

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair - mobilization

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis release anterior superior and
posterior

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Debridement of the footprint
Lichtenberg, Habermeyer, Magosch

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Anchor / sutures
1 anchor (partial tear)
2 anchors (complete tear)
Lichtenberg, Habermeyer, Magosch

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
ANCHOR INSERTION

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
 Knot tying
Lichtenberg, Habermeyer, Magosch

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair – suture management

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair - final

www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
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