Artros

Center for Orthopedic and Sports Injuries

Arthroscopic transosseous reconstruction of the rotator cuff

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rotatorcuffRupture of the rotator cuff tendons is the most common cause of shoulder pain after the age of 40. The most successful treatment of such defects is operational. In the Artros center, we were the first in Slovenia to introduce a new biological method of arthroscopic suture of the tendons without using artificial implants, which reduces the risk of complications and has a positive impact on the process of healing.

The rotator cuff is formed by tendons of four muscles (on the picture) located on the shoulder blade and are led trough the joint between the shoulder blade and humerus towards their attaching spot on the top of the humerus. The main function of these tendons, which are collectively referred to as the rotator cuff, is a dynamic stabilization of the shoulder joint and support of large superficial muscles in movements of elevation, external and internal rotation of the shoulder. Through the years, circulation of these tendons is gradually reduced, and in collagen fibers, degenerative changes begin to appear. These processes are already present after the age of 40, and they increase with aging. Tensile resistance of tendons gradually decreases, and damage, rupture can even at small uncontrolled overloading or sometimes spontaneously occur.

The first symptom of rotator cuff tendon failure is usually pain in the shoulder, which is present even during rest and especially at night. With the advancement of tendon damage, extent of shoulder flexibility begins to decrease, the strength of moving the arm away from the body also decreases. The most effective method of treatment is surgical. Crucial to the outcome of treatment, an early recognition of tendons failure and their stitching is sufficient, which prevents the progression of the decaying of the rotator cuff and the development of irreversible damage. Arthroscopic minimally invasive stitching of tendon rupture is the dominant mode of surgical treatment in which, with the usage of endoscopic camera through a tiny, less than a centimeter large surgical cut, the damaged tendon is stitched back to its primary place on the humerus.
In standard operation, for attaching the tendon to its primary position on the bone, different implants to which the stitches are attached to, are used. With stitching we achieve a stable attachment of the free edge of the tendon to the upper arm, in that way, during the  healing process, allowing the tendon  to  re-cicatrize with the bone.

With the new method where the tendon is biologically stitched, artificial implants, through which the stitches are attached to the bone, are not needed any more. Instead of these, we use an instrument, which is designed especially for this operation, by which the stitch is led directly through the bone and then the torn ligament is pushed to the bone. The advantages of such stitching are numerous, one of the most important is the absence of artificial implants, which are otherwise located in the bone just below the surface on which the tendon is attached, and consequently the processes of circulation and cicatrization are disrupted. In some cases, these implants also cause resorption of the surrounding bone, in the worst case migration of the implant from the bone is possible, causing the repetition of problems. A new biological method of stitching the rotator cuff has been proved in several studies as safe and effective. Given the good experience with this method in our center, it became a standard method of operative treatment of the rotator cuff tear.

Artros

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