| Abstract ID |
| 20260118 |
| Category |
| Shoulder: Rotator Cuff |
| Preferable Presentation |
| Both |
| Title |
| A NOVEL ARTHROSCOPIC TECHNIQUE FOR HYBRID DOUBLE-ROW REPAIR USING A CANCELLOUS SCREW AND WASHER FOR ENHANCED LATERAL-ROW FIXATION IN OSTEOPOROTIC MASSIVE ROTATOR CUFF TEARS |
| Author |
|
| Presenter |
| Pakorn Chawanpaiboon |
| Abstract |
| Purpose Massive rotator cuff tears in osteoporotic bone often fail due to many factors, including poor anchor fixation. We present an innovative arthroscopic hybrid double-row repair using a unicortical cancellous screw and washer for lateral-row fixation, combined with biceps superior capsular reconstruction. This method is designed to secure multiple suture limbs through a single screw while providing reliable bone purchase and maintaining footprint compression in fragile bone. Methods The patient was placed in a modified semilateral decubitus position. Intra-articular examination viewed from the posterior portal revealed a full-thickness tear of the subscapularis tendon, accompanied by a large tear of the posterosuperior rotator cuff. Capsular release was performed using a radio-frequency ablator. Single-row repair of the subscapularis tendon was performed using a double-loaded suture anchor, which aided in the reduction of the posterosuperior rotator cuff for subsequent repair. Subacromial viewing demonstrated a posterosuperior rotator cuff tear, with the supraspinatus tendon retracted to the glenoid. Rotator cuff mapping revealed cuff mobilization to the footprint facilitated by biceps tendon transposition. Two triple-loaded suture anchors were inserted at the anterior and posterior aspects of the rotator cuff footprint. Four suture limbs from two sutures of the posterior anchor were shuttled through the infraspinatus tendon, and the sutures were then tied. Sutures from the anterior anchor were passed through the long head of the biceps tendon and the supraspinatus tendons. The long head of the biceps tendon was tenotomized after the sutures were passed. The sutures passed through the long head of the biceps tendon were tied. Six sutures were retrieved through the cannula for lateral-row fixation. A Kirschner wire is initially placed to confirm a safe trajectory away from the axillary nerve, followed by a skin incision for a cancellous screw insertion as lateral-row fixation. Lateral-row fixation was performed using a 6.5-millimeter partially threaded cancellous screw with a washer. Three sutures were initially passed through the washer, and after the screw was fully tightened, each suture that had not passed through the washer was paired and tied with a suture that had passed through the washer, completing the final repair. Results The use of a cancellous screw with a washer as an alternative lateral-row fixation method provides adequate compression of the repaired tendon onto the footprint, maximizes tendon-bone contact area, and reduces gap formation at the repair site in posterosuperior rotator cuff tears. The cancellous screw achieves strong fixation within cancellous bone and enables reliable load distribution. In addition, multiple suture limbs can be secured by pairing a limb passed through the washer with a corresponding limb not passed through the washer for knot tying. Conclusion This technique provides a cost-effective and practical alternative to conventional suture anchors and may be particularly advantageous for osteoporotic patients with massive rotator cuff tears. When combined with biceps superior capsular reconstruction, it facilitates secure repair of the posterosuperior cuff and represents a reliable treatment option in this challenging population. |