Arthroscopic Repair of Anterosuperior Rotator Cuff Tears

Abstract

AbstractThe anterosuperior rotator cuff tear (ASRCT) is defined as the supraspinatus (SSP) tear that extends anterior to its border involving the rotator interval structures and subscapularis (SSC) tendon, which means the supraspinatus tear and subscapularis tear with or without biceps pathology. The physical examination regarding the supraspinatus tendon, subscapularis tendon, and biceps tendon could be positive, but the diagnosis also needs support from radiological evidence, especially from the magnetic resonance imaging. However, sometimes the diagnosis of partial subscapularis tear is difficult and always needs intraoperative evidence. Arthroscopic management of anterosuperior rotator cuff tear becomes the mainstream and routine procedure in our department attributed to the development of arthroscopic equipment and technology. Arthroscopic examination of the glenohumeral joint and diagnosis confirmation is performed from the posterior portal and then tenotomy of the long head of biceps and subscapularis repair is performed arthroscopically via the modified anterolateral portal. The extra-articular management of subscapularis tears is used in cases of large to massive subscapularis tears which need a complete release or anterior capsule reconstruction. Biceps tenodesis and supraspinatus repair are performed under visualization from the modified lateral portal. The limited bursectomy, knotless double row, and nanofracture during supraspinatus repair are recommended according to our research results.KeywordsAnterosuperior rotator cuff tearArthroscopySubscapularisSupraspinatusLong head of bicepsLimited bursectomyKnotless double rowNanofracture