kgrah71
New
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29826
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29827
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PREOPERATIVE DIAGNOSES:
1. Left shoulder rotator cuff tear.
2. Left shoulder long head of biceps tendinitis.
3. Left shoulder superior labral tear.
4. Evaluate for left shoulder chondromalacia.
5. Left shoulder subacromial bursitis.
6. Left shoulder subacromial impingement.
POSTOPERATIVE DIAGNOSES:
1. Left shoulder rotator cuff tear.
2. Left shoulder long head of biceps tendinitis.
3. Left shoulder superior labral tear.
4. Left shoulder chondromalacia.
5. Left shoulder subacromial bursitis.
6. Left shoulder subacromial impingement.
PROCEDURES PERFORMED:
1. Left shoulder arthroscopy, arthroscopic rotator cuff repair.
2. Left shoulder arthroscopic extensive debridement, including debridement of superior labrum, chondral tissue, and subacromial bursa.
3. Left shoulder arthroscopic subacromial decompression/acromioplasty.
4. Left shoulder open subpectoral biceps tenodesis.
INDICATIONS FOR PROCEDURE: The patient sustained injury to his left shoulder resulting in a full-thickness rotator cuff tear of the supraspinatus tendon. Additional pathology has been identified as detailed above. The patient has been indicated for left shoulder arthroscopy with rotator cuff repair, debridement, subacromial decompression, and possible open biceps tenodesis. The risks and benefits of the procedure have been explained to the patient in detail, and informed consent was obtained to proceed.
DESCRIPTION OF PROCEDURE: The patient was identified in the holding room, and the operative site was marked. The patient underwent a regional nerve block by the anesthesiologist in the holding area. The patient was then transferred to the operating room and placed supine on the operating room table. General anesthesia was induced. Preoperative antibiotics were administered. The patient was placed in the beach-chair position. The left upper extremity was positioned, prepped, and draped in the usual sterile fashion. A preoperative time-out was performed.
The left glenohumeral joint was insufflated with normal saline. The posterior portal was established, and the arthroscope was placed into the glenohumeral joint. The anterior portal was established using spinal needle localization. A diagnostic arthroscopy was then begun. The full-thickness tear of the supraspinatus tendon was confirmed. The subscapularis and infraspinatus tendons were overall intact.
The infraspinatus tendon did have some partial chronic articular-sided tearing off of the small portion of the greater tuberosity. There was no full-thickness tear of the infraspinatus tendon. The long head of the biceps tendon had some areas of tendinosis and fraying. There was a small superior labral tear. Additionally, extensive erythema and tissue inflammation/irritation was present at the biceps anchor on the superior labrum. Therefore, the decision was made to ultimately proceed with the biceps tenodesis. The radioablation of the biceps was used to divide the long head of the biceps tendon off of its attachments in the superior labrum.
Some grade 2 chondromalacia was present on some areas of the glenoid. This was debrided with a shaver. The small superior labral tear was debrided with a shaver.
The arthroscope was then placed into the subacromial space. The lateral portal was established in the standard fashion. The areas of inflamed and thickened subacromial bursa were present. The subacromial bursal tissue was debrided with the shaver. The undersurface of the acromial process was delineated with the radioablation device. An anterior subacromial spur was present. The arthroscopic bur was utilized to remove 5-mm of anterior acromial bone, performing an acromioplasty and achieving the subacromial decompression.
The bur was then utilized to lightly decorticate the rotator cuff footprint on the greater tuberosity. The supraspinatus tendon was mobilized. A rotator cuff repair was then performed with an Arthrex SpeedBridge construct, utilizing a total of four anchors. Successful and secure repair of the supraspinatus tendon was achieved. The arthroscopic instruments were then removed.
Attention was turned towards the open biceps tenodesis. A longitudinal incision was made on the anterior axillary region of the upper arm. The dissection was carried down through the superficial and deep tissue layers. The long head of biceps tendon was identified and retrieved out of the wound. A FiberLoop suture was used to whipstitch the tendon in the standard fashion. The anterior cortex of the humerus was exposed underneath the pectoralis major tendon. A bicortical guidepin was inserted. Unicortical reamer was utilized to create a tunnel in the anterior cortex of the humerus. Copious irrigation was performed.
The excess portion of the long head of the biceps tendon was divided beyond the whipstitching point. The cortical button was deployed in a bicortical fashion across the far cortex of the humerus. The button was toggled, and the sutures were advanced, docking the long head of the biceps tendon within the bony tunnel. A free needle was used to pass one of the suture limbs through the substance of the biceps tendon. Knots were tied down securely, completing the open biceps tenodesis.
The surgical sites were irrigated with normal saline. Hemostasis was verified. Vancomycin powder was applied topically at the surgical sites. Layered closures were performed, and sterile dressings were applied. The patient was awoken from anesthesia and transferred to the recovery room in stable condition. He tolerated the procedure well, and there were no complications. Sponge, needle, and instrument counts were correct at the end of the procedure.