Book Chapter

Oblique Reduction

Nicholas A. Ott, Kelly, Ann Marie, Kelly, John D., Ott, Nicholas A., John D. Kelly, Liane Miller, Ann Marie Kelly, Miller, Liane

2020

Overview

Advances in arthroscopic methods have provided significant improvements in visualization, characterization, and repair techniques of rotator cuff tears. However, the treatment of massive, retracted tears continues to pre sent a challenge. Although the most common individual tear pattern reportedly is of the crescent-shaped variety, most tears possess at least one mobile limb and require a side-to-side reduction due to the very narrow lateral width of the supraspinatus insertion, shown to be only 1.3 mm. 1 The infraspinatus tendon has been shown to insert anteriorly on the greater tuberosity as it blends with the supraspinatus footprint (Figure 6-1). Thus, tears with an exposed lateral footprint greater than 1.3 mm will usually require some mobilization to allow excursion infraspinatus tissue anteriorly or coracohumeral ligament tissue posteriorly. Crescent tears (Figure 6-2) that are repaired directly laterally with double-row constructs are usually malreduced and will predictably undergo excessive tension at the bone tendon junction (Figure 6-3). Massive cuff tears, which have a reported prevalence of nearly 40%, would be logically expected to pre sent a mobile limb, either anteriorly or posteriorly, in essentially all cases. 1 Tension is the bane of rotator cuff repair, 2 and it is the senior author's contention that in an effort to obtain a double-row construct, the art of tear reduction has been lost.

• Publisher: CRC Press,Taylor & Francis Group
• ISBN: 1630915629, 9781630915629