Shoulder Arthroscopy

Irreparable rotator cuff tears have long been a challenge for orthopedic surgeons and historically have had limited surgical techniques with good clinical outcomes. These types of tears can often result in superior humeral head migration along with pain and limited range of motion for the patient.

This procedure involves use of a graft secured to the glenoid and greater tuberosity to reconstruct the superior capsule, restoring joint function and superior glenohumeral stability. Studies have shown that repairing the superior capsule can significantly improve acromiohumeral distance and ASES scores.¹

Clinical studies have shown that ECMs like Allopatch HD^® are stronger, exhibiting better suture retention and greater ultimate load failure rates than synthetics and xenografts.² In addition, Allopatch HD^® requires no refrigeration or rehydration and is ready to use off the shelf almost immediately. It’s minimally processed and not crosslinked, which better preserves and maintains the graft’s natural biomechanical, biochemical, and matrix properties.

When faced with a repairable PASTA lesion (typically small tendon retraction and 40-50% footprint exposure), surgeons have two options: either complete the tear followed by a standard rotator cuff repair, or maintain the remaining bursal fibers and perform a transtendinous repair.

Studies have shown drawbacks to completing the tear, including creating a length tension mismatch¹, changing the normal biomechanics of the cuff, and creating a greater potential for non-anatomic recreation.² Conversely, comparing these two approaches has shown a transtendinous approach provides less statistically significant gapping, higher mean ultimate failure strength, and biomechanic superiority.²

A transtendon approach is a reliable procedure that can be expected to produce a good outcome with significant pain relief and improved shoulder scores in 98% of patients.^3,4 Studies have shown that smaller anchors cause less damage to tendon tissue and suggest smaller anchors should be considered for transtendon procedures.⁵ CONMED’s Y-Knot^® Flex All-Suture anchor provides distinct advantages for transtendinous PASTA repair techniques.

The proximal biceps tendon is a common source of pain, fraying, or tearing. In many cases, it is simply released from its attachment at the superior labrum. Other patients may benefit from a tenodesis, or reattachment, of the tendon at a different location. Tenodesis of the biceps tendon can prevent cosmetic deformity¹ and may preserve strength.²

There are a number of arthroscopic approaches to proximal biceps tenodesis, namely soft tissue tenodesis, subpectoral or suprapectoral tenodesis, or tenodesis within the bicipital groove. Techniques can also vary in whether the tendon is fixated within the bone or on top of cortical bone. CONMED has various anchor offerings to support each approach.

The labrum lines the glenoid, creating a rim that deepens the glenoid cavity and aids in keeping the humeral head in the joint. Labral tears are commonly associated with dislocation of the shoulder. These tears are referred to as Bankart lesions and indicate a tear at the anterior to inferior portion of the labrum. A Reverse Bankart lesion refers to a posterior to inferior tear of the labrum. A SLAP tear is a tear of the superior portion of the labrum.

Labral tears can be treated with an arthroscopic repair that involves securing the labrum back to the glenoid and, if necessary, tightening the joint capsule. CONMED offers multiple anchor material options to complete these procedures.

In addition to anterior glenoid bone loss, patients with traumatic shoulder instability may also experience bone loss of the posterolateral humeral head – often referred to as a Hill-Sachs lesion. Depending on the size and position of the Hill-Sachs lesion, the lesion may engage with the anterior glenoid rim upon certain movements. The role that Hill-Sachs lesions play in recurrent instability1 have led many to address them through a technique called Remplissage.¹

For this technique, the lesion is “filled” by infraspinatus tenodesis and posterior capsulodesis to prevent the lesion from engaging with the glenoid rim. Studies have shown favorable results in using Remplissage to address Hill-Sachs lesions and prevent recurrent dislocation, reporting failure rates of 0-15%.(^2-7)