Boonyanuwat Wittawat, Charoenthamruksa Chatchavan, Nartthanarung Adisak, Kongmalai Pinkawas
Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
Department of Orthopedics, Faculty of Medicine, Kasetsart University, Bangkok, Thailand.
Arthrosc Tech. 2025 Mar 11;14(6):103510. doi: 10.1016/j.eats.2025.103510. eCollection 2025 Jun.
We present a tendon-preserving approach for massive rotator cuff tears, focusing on the subacromial space rather than entering the glenohumeral joint. This technique aims to minimize iatrogenic injury to already compromised tendons, particularly the infraspinatus, while improving visualization and surgical efficiency. By accessing the subacromial space first, manipulation of retracted and weakened posterior cuff tissues is avoided, reducing the risk of further damage. The procedure is performed in the beach-chair position using 4 portals strategically placed for optimal visualization and precise anchor placement. After addressing the subscapularis tear, a double-row supraspinatus repair is completed without the need for intra-articular exploration. Preserving tendon integrity may enhance biomechanical stability and potentially decrease retear rates. Additionally, the retracted tendon edges often provide an indirect view of intra-articular structures, allowing for the management of biceps or labral lesions. Although selective intra-articular inspection may still be required in certain cases, this approach represents a paradigm shift in managing massive cuff tears. Future studies comparing outcomes, such as functional recovery and retear rates, with conventional intra-articular techniques are warranted to further validate this subacromial-first method.
我们提出了一种用于治疗巨大肩袖撕裂的保留肌腱方法，重点关注肩峰下间隙而非进入盂肱关节。该技术旨在将对已受损肌腱（尤其是冈下肌）的医源性损伤降至最低，同时提高可视化程度和手术效率。通过首先进入肩峰下间隙，可避免对回缩和减弱的后袖带组织进行操作，从而降低进一步损伤的风险。手术在沙滩椅位进行，使用4个精心放置的切口以实现最佳可视化和精确锚钉置入。处理肩胛下肌撕裂后，无需进行关节内探查即可完成双排冈上肌修复。保留肌腱完整性可能会增强生物力学稳定性，并有可能降低再撕裂率。此外，回缩的肌腱边缘通常可间接观察关节内结构，便于处理肱二头肌或盂唇损伤。尽管在某些情况下可能仍需要进行选择性关节内检查，但这种方法代表了治疗巨大肩袖撕裂的一种范式转变。有必要开展未来研究，将该方法与传统关节内技术在功能恢复和再撕裂率等结果方面进行比较，以进一步验证这种先处理肩峰下间隙的方法。
