Χειρουργικές επιλογές για την αύξηση της λειτουργικότητας του τενοντίου πετάλου του ώμου – Surgical options to increase functional ability of the cuff

-Dynamic stabilizer of the shoulder -Couple forces stabilize and regulate the motion of the shoulder -Internal and external rotation of the shoulder

-RC is a functional-anatomic unit rather than four unrelated tendons -injury to one component has an influence to all others

Rotator cuff tears lowers the functional reserves of the shoulder When the functional demands of the patient exceeds the reserves of the remaining intact rot cuff clinical symptoms are produced

-Lower the functional demands of the patient (persuation) -Repair the cuff -Increase the functional capacity of the remaining cuff physiotherapy , partial repair , InSpace balloon, reconstruction of the superior capsule -Tendon transfers

-Balanced force couples -Stability of the edges -Strong fixation -Repair without tension

Chronicity of tear (duration of symptoms) Fatty infiltration more than stage 3-4 according to Goutallier classification (more fat than muscle) Patte tendon retraction stage 3 (tendons to the glenoid) Acromiohumeral distance <2mm Rot cuff arthropathy

We must be able to: -Recognize the tendons -Release the tendons completely -Fix the tendons without tension

Identify recognizable landmarks -the undersurface of the acromion and -the anterolateral corner -the acromio-clavicular joint -the spine of the scapula -the lateral border of the tuberosity

-The coracoid -The acromion -The glenoid

-Complete repair -Partial repair -Debridement, biceps tenotomy

Burkhart et al. showed satisfactory results in 13 of 14 patients with unrepairable RCT managed with partial repair at an average follow-up of 21 months. Arthoscopy 1994

Materials and methods: All patients (67 cases) were arthroscopically treated with functional repair of the posterior cuff. The follow-up was at least 5 years. All the patients had clinical and radiographic evaluations and assessment with the Simple Shoulder Test and Constant score. Results: The mean Constant score increased from 44 points to a mean of 73 points, the mean Simple Shoulder Test score increased from 4.6 to 9.0, and the mean AHD increased from 6.1 mm to 9.1 mm. Discussion and conclusion: Functional repair of the infraspinatus, leaving the greater tuberosity uncovered, in patients with irreparable cuff tears gives good results in terms of patient satisfaction and in restoring the AHD even at long-term follow-up. Complications were rare and in line with the usual sequelae of a rotator cuff repair.

All arthroscopic technique including : -double row repair wherever possible, -single row repair, -margin convergence, -side to side sutures -Anterior &/ Posterior Slide

-Joint-preserving procedure -Improves biomechanical stability of the shoulder -But it is a technically challenging procedure -Promising results even in patients with pseudoparalysis

Goal is to achieve painless ROM avoiding friction between the tendons, the humeral head and the undersurface of the acromion . Provides sufficient lever and tension to the Deltoid to produce forward flexion and abduction in the early phase of rehabilitation

Very easy technique with Promising initial results Subjective pain relief Improved shoulder function Patient selection is important

Our philosophy of the use of sub-acromial spacer: Pain as the main complaint Loss of motion due to pain Intact or repairable subscapularis We use the balloon as an additional treatment option to debridement or partial repair

For posterosuperior tears Latissimus dorsi transfer Lower trapezius transfer For anterosuperior tears Pectoralis major transfer Latissimus dorsi transfer

The goal is not to cover the humeral head but to establish a balanced force couple centering the head.

Younger patients When loss of power is the main complain Technically demanding procedures