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WAIKOLOA, Hawaii — In a presentation at Orthopedics Today Hawaii, Mark A. Mighell, MD, discussed intraoperative and post-operative complications in rotator cuff repair and how to handle these complications.

In patients with cysts or poor-quality bone, Mighell said in his presentation that it is important to get the tendon to heal. He noted nonoperative treatment is ideal because a tear associated with a cyst is not traumatic in nature. However, when surgery is needed for a large cyst, Mighell said to take care of the poor-quality bone.

For patients with poor tissue quality, Mighell noted previously published literature has shown good results infusing the tendon with fiber tape.

He advised to always be prepared in the event of a large rotator cuff tear that is medialized to the glenoid and the tissue is immobile.

“Always be prepared to have something there available and, in this case, we chose to use one of those dermal grafts,” Mighell said.

He continued, “That means you are looking at your MRI scan [and] you are doing preoperative planning. You do not want to get into surgery and then find you cannot fix the tendon.”

When performing superior capsular reconstruction to repair large rotator cuff tears with immobile tissues, Mighell recommended using a graft in which the medial dimensions are 30 mm, the lateral dimensions are 40 mm and the length is about 50 mm. He also noted that surgeons should create holes large enough to pass sutures through without becoming tangled or flipped.

“I always like to incorporate the infraspinatus, whether I put an anchor in or do a side-to-side to repair it,” Mighell said.

For postoperative complications, Mighell noted stiffness becomes a real problem in 3% to 5% of cases. Although most patients who are stiff early on have better outcomes, according to Mighell some patients may need to undergo capsular release due to adhesions and scarring around the subscapularis and thickening of the anterior capsular. He cautioned to perform the release gently so as not to retear the rotator cuff.

“The last thing you want to do is manipulate your patient that you just fixed a rotator cuff and tear out your rotator cuff repair,” Mighell said. – by Casey Tingle

Disclosure: Mighell reports he is on the speakers bureau and is a paid consultant for DJO Surgical and Stryker, receives royalties from DJO Surgical and receives research support as a primary investigator for Stryker.

By: Casey Tingle

January 23, 2019