Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results.

PURPOSE: We describe a novel all-arthroscopic technique for suprascapular nerve (SSN) decompression and present our preliminary results for this procedure. METHODS: A prospective series of 10 patients with preoperative electromyographic findings consistent with chronic SSN compression, posterior shoulder pain, and subjective weakness were treated with arthroscopic SSN decompression. There were 8 men and 2 women, with a mean age of 50 years. The mean follow-up was 15 months (range, 6 to 27 months). In 8 of 10 patients, we performed an electromyographic examination postoperatively to evaluate nerve recovery after decompression. The clinical outcomes measures used to assess preoperative and postoperative function were the visual analog scale for pain, the Constant score, strength testing of the supraspinatus and infraspinatus, and a subjective satisfaction questionnaire. In all patients preoperative and postoperative computed tomography arthrograms were obtained to document the absence of a rotator cuff tear. RESULTS: There were no complications resulting from SSN decompression. Of 10 patients, 8 had postoperative electromyography at a mean of 6 months after SSN release and 2 refused to undergo this study after surgery. Of the 8 postoperative electromyograms, 7 had complete normalization of the latency in the motor fibers of the SSN and normalization of the voluntary motor action potential for the supraspinatus and infraspinatus muscles. Two of the electromyograms showed evidence of partial recovery. The preoperative and postoperative Constant scores for these patients were 60.3 and 83.4, respectively (P < .001). All patients returned to their normal work and sports activity at a mean of 3 weeks (range, 2 days to 3 months). The abduction and external rotation strength also significantly improved. At the time of last follow-up, 9 patients graded their clinical outcome as excellent and responded that they had complete relief of pain. One of the study subjects reported a satisfactory result with moderate relief of pain. CONCLUSIONS: Arthroscopic release of the SSN can be performed safely and effectively. All of the patients in this preliminary study had improvement in their postoperative electromyographic findings and had marked improvement in pain relief and function. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations.

PURPOSE: The purpose of this study was to evaluate arthroscopically the frequency and type of instability of the long head of the biceps (LHB) tendon in patients undergoing rotator cuff repair. METHODS: In 200 consecutive patients undergoing arthroscopic rotator cuff repair, LHB instability was assessed statically and dynamically in the anteroposterior direction. In addition, macroscopic lesions of the LHB, as well as lesions of the adjacent rotator cuff tendons, were documented. RESULTS: LHB instability (subluxation or dislocation) was found in 45% of patients, with isolated anterior instability in 16%, isolated posterior instability in 19%, and combined anteroposterior instability in 10%. Whereas LHB subluxations were observed in both directions, dislocations were only seen in anterior LHB instability. Anterior instability was more associated with a subscapularis lesion, whereas posterior instability was more associated with a supraspinatus tear. Lesions of the LHB tendon were strongly associated with LHB instability and the size of the rotator cuff tear. CONCLUSIONS: In 200 patients with rotator cuff tears LHB instability could be observed arthroscopically in 45%, with 16% being anterior, 19% being posterior, and 10% being anteroposterior. LHB instability was associated with LHB lesions, with 15% of the LHB tendons showing a normal appearance when unstable versus 70% when stable. Preoperative O'Brien and Speed tests did not correlate with intraoperative observed LHB pathology. The size of the rotator cuff tear could be correlated with the grade of LHB lesion, becoming more significant with augmenting tear size. On the basis of these observations, we created a new arthroscopic classification of LHB instability with respect to the direction and extent of LHB instability, lesions of the LHB, and status of the adjacent rotator cuff tendons. LEVEL OF EVIDENCE: Level IV, diagnostic study with poor reference standard.

Footprint fixation for arthroscopic reconstruction in anterior shoulder instability: the Cassiopeia double-row technique.

Footprint fixation with a double-row technique is a new concept for arthroscopic capsulolabral reconstruction in anterior shoulder instability. The described double-row fixation technique with 2 suture anchors on the glenoid neck and 3 on the glenoid rim allows healing of the capsulolabral complex to a broader bony surface and not only to the thin glenoid rim as achieved with current techniques. Because the anchor insertion W-shaped form resembles the star constellation of Cassiopeia, this technique is called the Cassiopeia double-row technique. The restoration of the original capsulolabral footprint with the Cassiopeia double-row technique by a stronger fixation should decrease recurrence rates of instability after arthroscopic stabilization but we need longer follow-up and larger numbers of patients to confirm.

Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation.

This article presents an all-arthroscopic technique for coracoclavicular ligament reconstruction by ligamentoplasty after acute or chronic acromioclavicular joint dislocation. A coracoacromial ligament transfer is done to reconstruct the torn coracoclavicular ligaments, similar to open surgery. The coracoacromial ligament is dissected from the undersurface of the acromion and is reinserted on the inferior clavicle by transosseous suture fixation. Additional wire or screw stabilization may be used. With this method, we achieve a very satisfactory reduction of the dislocated acromioclavicular joint.