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Arthroscopic transosseous rotator cuff repair: how to avoid damaging the axillary nerve—a cadaveric study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Arthroscopic transosseous rotator cuff repair can be performed with an external guide, although the proximity to the axillary nerve raises safety concerns. The aim of this study is to determine the safety of different drilling angles regarding the axillary nerve.

Materials and methods

We performed a bone tunnel in the greater tuberosity in 17 fresh frozen shoulders, using an external guide at four different angles: 40°, 50°, 60°, and 70°. At each angle, we measured the distance between the drill and the axillary nerve, the distance from the acromion to the skin incision point, and the perimeter of the arm at the axilla.

Results

The distance to the axillary nerve was safe with the guide at an angle of 40°, 50° and 60°, but not at 70° (p = 0.001). We found significant differences between all four angles (p < 0.05). Regression analysis demonstrated the influence of the guide angle in all measurements assessed (p < 0.001). There was no association between the measurements taken and the axillary perimeter (p > 0.5).

Conclusions

Arthroscopic transosseous rotator cuff repair with an external guide does not pose a risk for the axillary nerve using angles of 60° or less.

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Authors and Affiliations

  1. Servicio de Cirugía Ortopédica y Traumatología, Upper Extremity Unit, Hospital Universitario Dr. Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain

    José Antonio Blas-Dobón & Daniel Montaner-Alonso

  2. Upper Extremity Unit, Hospital Universitario de La Ribera, Alzira, Spain

    Luis Aguilella

  3. Unit of Public Health and Environmental Care. Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, Valencia, Spain

    Maria Morales-Suárez-Varela

  4. CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Maria Morales-Suárez-Varela

Authors
  1. José Antonio Blas-Dobón
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  4. Maria Morales-Suárez-Varela
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JABD, LA, DM and MM. The first draft of the manuscript was written by JABD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to José Antonio Blas-Dobón.

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Conflict of interest

José A. Blas-Dobón, Luis Aguilella, Daniel Montaner-Alonso and Maria Morales-Suárez-Varela declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with live human participants or animals performed by any of the authors. This study fulfilled all the ethics requirements of the dissection room and Anatomy Department.

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Blas-Dobón, J.A., Aguilella, L., Montaner-Alonso, D. et al. Arthroscopic transosseous rotator cuff repair: how to avoid damaging the axillary nerve—a cadaveric study. Arch Orthop Trauma Surg 140, 1767–1774 (2020). https://doi.org/10.1007/s00402-020-03528-x

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