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All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results

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HSS Journal ®

Abstract

Background

Traditional intra-articular arthroscopic repair techniques for massive anterosuperior rotator cuff tears are technically demanding and necessitate sacrifice of the rotator interval to enable visualization. An interval slide allows mobilization through release of the medial aspect of the rotator interval, while leaving the lateral, bridging fibers intact.

Questions/Purposes

The purpose of this study was to report a novel, arthroscopic, open-equivalent technique using the subdeltoid space to address these tears along with early clinical results.

Methods

A retrospective review of prospectively collected data identified 11 consecutive arthroscopic massive anterosuperior rotator cuff repairs with a concomitant biceps tenodesis performed by the senior surgeon using a uniform technique. Outcome measures included range of motion, visual analog scale for pain, rotator cuff strength, American Shoulder and Elbow Surgeons (ASES) outcome scale, and Short Form-12 (SF-12).

Results

Average length of follow-up was 22.2 months (range 12.5–30.0 months). Visual analog scale (VAS) pain scores, ASES, and SF-12 all demonstrated significant improvement from pre-op to final follow-up from 6.2 to 0.9 (p < 0.05), 27.4 to 82.8 (p < 0.05), and 26.6 to 45.5 (p < 0.05) respectively. Average forward flexion improved from 145° to 160° (p < 0.05). Seven of the nine patients with a positive preoperative belly press had a negative test at final follow-up. Nine of the 10 patients with a positive lift off test demonstrated a negative test on final follow-up. Ninety-one percent reported they were satisfied with their outcome.

Conclusions

The described modified all-arthroscopic subdeltoid approach for anterosuperior cuff repairs enabled an open-equivalent interval slide technique that preserved the bridging lateral fibers of the rotator interval and demonstrated promising early-term clinical results.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Keith T. Corpus MD, Samuel A. Taylor MD, Stephen J. O’Brien MD, MBA & Lawrence V. Gulotta MD

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  1. Keith T. Corpus MD
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  2. Samuel A. Taylor MD
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  3. Stephen J. O’Brien MD, MBA
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  4. Lawrence V. Gulotta MD
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Correspondence to Keith T. Corpus MD.

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Conflict of Interest

Keith T. Corpus, MD, Samuel A. Taylor, MD, Stephen J. O’Brien, MD, MBA, and Lawrence V. Gulotta, MD have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was waived from all patients for being included in the study.

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Level of Evidence

Case series, Level of evidence IV

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Corpus, K.T., Taylor, S.A., O’Brien, S.J. et al. All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results. HSS Jrnl 12, 200–208 (2016). https://doi.org/10.1007/s11420-016-9497-5

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