October 2010 Volume 26 issue 10
On the Cover: A 25-year-old man with a history of falling onto his right shoulder while skiing presented with pain and an inability to abduct his arm. Radiographs documented a large greater tuberosity fracture with significant displacement presumably due to rotator cuff retraction of the avulsed fracture fragment. MRI further delineated a comminuted greater tuberosity fracture with complete adherence of the supraspinatus to the avulsed bony fragment. The patient was scheduled for AxRIF 10 days after injury. Ax evaluation confirmed the above findings. Using the technique described by Song et al. in the August 2008 issue of Arthroscopy (2008;24:956-960), two medial row anchors were placed in the fracture bed juxtaposed to the medial articular cartilage margin with suture pairs being shuttled medial to the avulsed bony fragment for horizontal mattress suture placement. The fragment was reduced with a K-wire and Ax knots were then tied. Two lateral row “Footprint” anchors (5.5 mm; Smith & Nephew, Andover, MA) were then placed along the lateral vertical wall of the proximal humerus and a suture bridge type construct was secured. The in situ tensioning afforded by the “Footprint” anchors allowed for fracture fragment adjustment with subsequent re-tensioning of the suture bridge construct. Postoperative day 10 radiographs revealed an anatomically reduced greater tuberosity fracture fragment. Courtesy of Yuri M. Lewicky, M.D.
February 2010 Volume 26 issue 2
On the Cover: A 56-year-old man with an acute, sudden onset of pain and an inability to abduct his arm following a work-related injury presented to my clinic. MRI revealed a massive rotator cuff tear with retraction to the level of the glenoid articular surface. Arthroscopic evaluation from the subacromial space revealed a completely unroofed glenoid surface (top left). Two double-loaded medial-row anchors reapproximated the cuff to its native footprint (top right), while a third anchor closed the posterior interval between the supra- and infraspinatus with side-to-side sutures (bottom left). A single PushLock along the lateral humeral cortex secured the repair with added cuff compression. Final arthroscopic images revealed a completely reconstructed rotator cuff with 100% supraspinatus footprint coverage (bottom right). Courtesy of Yuri M. Lewicky, M.D.
May 2009 Volume 25 Issue 5
On the Cover: A 62-year-old patient with a history of two previous rotator cuff tear repairs over the span of 15 years presented with clinical and MRI documentation of a chronic massive rotator cuff re-tear encompassing 100% of the supraspinatus and 75% of the infraspinatus tendons. The arthroscopic image shows the supraspinatus footprint on the right and the humeral head articular cartilage on the left. Note the branching neovascularization of the chronically exposed cuff footprint seeking out cuff to adhere to. As previously described in the literature, it is evident that the rotator cuff repair blood supply primarily comes from the bone. In this particular case the rotator cuff had completely scarred against the undersurface of the acromion, obliterating the subacromial space. A careful and cautious arthroscopic dissection allowed for full cuff mobilization and repair using an all arthroscopic transosseous-equivalent repair technique. Courtesy of Yuri M. Lewicky, M.D.
June 2008 Volume 24 Issue 6
On the Cover: A 48-year-old man with a chief complaint of long-term pain and weakness presented to my clinic. Magnetic resonance imaging revealed a SLAP tear and chronic severe rotator cuff tendonopathy of the supraspinatus. On arthroscopic evaluation, a type II SLAP lesion was apparent and a PASTA lesion with a footprint >10 mm was exposed. To address the SLAP lesion, an anteromedial glenohumeral portal (just off the superior border of the subscapularis in the rotator interval) was placed, as was an anterosuperior glenohumeral portal through the PASTA lesion's medial extension. After the SLAP repair was completed, a final arthroscopic image was taken for documentation when what should appear but the “face of creativity.” As arthroscopists, we are constantly creating improved techniques and instruments, and defining undefined pathology to better serve our patients. And sometimes when you least expect it, the “face of creativity” simply happens and needs only to be recognized. Courtesy of Yuri M. Lewicky, M.D.
