The Rotator Cuff Repair Mess

Abstract

To the Editor: I reached orthopaedic surgery led by the hand of my father, Jose M. Palomo, as well as Lorenz Bohler (The Treatment of Fractures) and Sir Reginald Watson-Jones (Fractures and Joint Injuries). Soon afterward, at the faculty ofmedicine, I learnedabout Sir JohnCharnley (The Closed Treatment of Common Fractures). Until that moment, a bony fracture meant some kind of cast and traction, as well as the dictum, “Close open fractures but don’t open the closed ones.” I had to give up that knowledge to closely and religiously follow, in a successive and exclusive way, the immovable principles of Maurice Muller (AO plates and screws), Gerhard Kuntscher and Josef Ender (intramedullary nails), R. Hamilton Russell (balanced suspension skeletal traction), Augusto Sarmiento (functional casts), Klaus Klemm and Dieter Schellman (locked nails), AO LISS plates, and nowadays, MIPO locked plates. Shall theydlocked platesdremain forever or will any of the previously abandoned “obsolete” techniques return to the present time, the sameway theFoucault pendulumalways returns to its starting point? It is now nearly 30 years since I started performing arthroscopic surgery of the knee, and although it has quite progressed, that development has maintained a certain predominant direction without too many bends except for extra-articular techniques and double-bundle ACL reconstruction. Shoulder arthroscopy has evolved quite differently. For rotator cuff repair, I started my training following Gary Gartsman, and so my metallic anchors went to the lateral aspect of the humerus to send their threads in an inverted mattress stitch configuration, in a single row, to push the cuff against its footprint. I then shifted to simple stitches from doubleloaded metallic anchors inserted at the top of the footprint (a la Stephen Snyder) and to absorbable top and medial anchors (a la Stephen Burkhart) to configure double-everted mattress stitches brought to a second single row of PEEK anchors distal to the lateral edge of the greater tuberosity. Then came the triple-loaded metallic anchors, just to fight the SutureBridge configuration, polyester suture-based anchors, not to mention all the transosseous-equivalent constructs, which were followed by the anchorless real transosseous device. Modified Mason-Allen stitches and rip-stop constructs, as well as reconstructive tissue matrices, then came to close the loop.up to a few months ago. I have now returned, very much in the way the Foucault pendulum