Buyukdogan Kadir, Koyuncu Ozgur, Eren Ilker, Birsel Olgar, Fox Michael A, Demirhan Mehmet
Department of Orthopedic Surgery, Koc University School of Medicine, Zeytinburnu/İstanbul, Turkey.
Department of Orthopaedic Surgery, VKV American Hospital, Teşvikiye, Sisli/İstanbul, Turkey.
Arthrosc Tech. 2019 Sep 21;8(10):e1193-e1200. doi: 10.1016/j.eats.2019.06.008. eCollection 2019 Oct.
Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair.
肩袖撕裂的分层给外科医生带来了挑战。识别并修复这种复杂的撕裂模式通常需要创新方法来实现足迹的解剖学修复。在本技术说明中，我们描述了我们首选的方法，即采用无结骨隧道等效技术分别对分层肩袖撕裂的两层进行解剖修复。以收紧缝合的方式在关节层放置两根缝线。然后，闭环端缝线穿过两层，同时将闭环端留在工作通道处。收紧缝线的自由端用预加载的纤维带环加载到锚钉上，该纤维带环放置在内侧排，同时将关节层贴合到其足迹上。然后借助先前放置的闭环缝线，将纤维带穿梭穿过肌腱的两层。最后，在以交叉桥配置张紧纤维带的同时放置外侧排锚钉。我们认为，该技术通过提供骨隧道等效修复的生物力学特性，可能有助于分层肩袖的顺利愈合。
