Schulter

Fasszange für Rotatorenmanschetten

Die Rotatorenmanschettenfasszange ist mit einem langen Schaft und einem breiten, langen Maulteil ausgestattet, um ein sicheres Fassen von Gewebe bei Rotatorenmanschetteneingriffen zu ermöglichen. Die Zangen der Reihe "SR" besitzen eine selbstlösende Arretierung, die sich durch einfaches Spreizen der Handgriffe leicht lösen lässt. Die Zangen der Reihe "NR" besitzen Handgriffe ohne Arretierung, um den Einsatz bei schwierigen Handpositionen während der Operation zu erleichtern. Die Fasszangen der WishBone™-Serie sind mit einem selbstarretierenden Verschlussmechanismus ausgestattet, der gelöst werden kann, sodass ein Einsatz ohne Arretierung möglich ist.

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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Matt Ravenscroft, MBBS, FRCS (Manchester, UK), discusses bursal acromial reconstruction (BAR), an innovative technique for irreparable rotator cuff tears. Mr. Ravenscroft uses the BAR technique to attach ArthroFlex dermal allograft to the underside of the acromion, which provides a protective covering that helps prevent humeral-acromial contact for pain relief in low-demand patients. He also shares his clinical results over the past 2 years and highlights a case example.
ArthroFLEX® is a registered trademark of LifeNet Health.

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Bursal Acromial Reconstruction Case Presentation

Hello, I'm Matt Ravenscroft from the UK. Today in this video, I'm going to show you an update on the results of the bar and show a case study. We do know there are lots of options for irreparable cuff tears. We have débridement partial repair. We can cut the biceps, do tendon transfers, and of course there's the scar. I'm also going to comment on the balloon, but the one I'm going to talk about today is the Bursal. Acromial reconstruction is CRx suitable for all patients where we know it works well in the younger patient and no arthritis. A good cuff, a good functioning shoulder without any arthritis. But that's not every patient. So in the elderly patient with no arthritis, with a good compensated shoulder we want to preserve the joint. And that's where we came up with the acromion reconstruction. So it's a graft a human graft, which we fixed to the undersurface of the chromium. And then the humeral head bears on this, which stops the pain. It acts as a cushion in between the humeral head and the acromion. But Gus Matsakis study actually showed it also helped to recenter the head, reduce some of the forces on the deltoid, and to more normalize a defective cuff shoulder. So my results for the bar. My first case was in December 17th. We have 78 cases in the series with MRI scans at three months and six months. Average male and female distribution and average age, as we've mentioned, is the elderly group late 70s, early 80s. The biceps was absent in two thirds of the patients, meaning the benefit they received wasn't just because we cut the biceps and on MRI scanning, all the graphs have healed. If you look at the visual analog score, these were painful shoulders, compensated shoulders, but painful, with the average visual analog score of about eight and a half going down to one and a half at a year. And that was maintained. So it's not a no pain, but it's a pain that people are very happy and very able to deal with. And the same for the Oxford shoulder score. We started off with a good score. So these patients were compensated. They had good function but just pain. So the increase in the Oxford shoulder scores because of their pain relief on the scans, we can see at three months you can see a fluid line between the graft and the undersurface of the acromion. At six months that's gone. So the graft heals. And this is a pretty typical patient. He's 83 years old. He plays golf, and it's his left shoulder. These are his MRI scans, and he has now no pain. Good function. And he's back playing golf. We also noticed on the MRI scans at about a year that the graft forms a meniscus. It's form follows function. So it shapes and contours to the surface of the humeral head. Of course, we can't talk about results without talking about complications. I had one patient who felt something go, and it was one of my sutures or a knot that failed. I trimmed that back, and she was fine. I had one patient with a acromial pain and that settled down. I had no infections early on in my series. I used to resect the clavicle and the acromion, but in two patients had an acromial stress fracture. Now, I don't do that. I just reset the lateral clavicle. And I've found I haven't had that complication anymore. So this is a case study. I mentioned she's an 82 year old lady, a very keen marathon runner. She'd had a previous failed repair. I did a balloon on her and she had initial pain relief. But then the pain came back and she wanted to now a more permanent Fixed, so I did a burst of chromium reconstruction on her. At the time of doing the surgery, she was nine months post balloon and I could see as on the video, a lot of plastic debris still in the synovium. I did the bar on her and she's done very well at three months and at six months and a year, and now three years, she's still doing very well. And importantly, she's still running. And this is her. It's her right shoulder. She has a good full range of movement with no pain. And she's happy. So looking at my results and comparing my results of my bar to my balloon. So I have more bar 78 versus 32 balloons. The Oxford shoulder score needs to be more than six to be significant. And it wasn't in the balloon, but it is in the bar. Complication rates was only 5% in the bar and a much smaller revision to reverse. So this is how it all fits in with my treatment algorithm of CRx in the younger patient bar, in that more elderly patient who I want to try and preserve the joint. And if we're not going to preserve the joint, then we still have the option, obviously, of a reverse. Thank you very much for watching this video.

Stephen S. Burkhart, MD, (San Antonio, TX) discusses the history of double-row rotator cuff repair and highlights the latest anchor options that incorporate knotless tensionable technologies, including Knotless SutureTak®, Knotless Corkscrew®, and Knotless SwiveLock® suture anchors.

Presentation Videos

Knotless Medial and Lateral Row Rotator Cuff Repair

Good morning. I'm Steve Burkhart from San Antonio, Texas. I'm going to talk to you about Nautilus medial and lateral row rotator cuff repair. So in doing this we're going to basically give you a short history of nearly everything about double row cuff repairs. So the double row evolved from being two separate rows medial and lateral to this linked double row configuration. So why would this be superior? There are anatomic, biomechanical and clinical considerations here. Anatomically, the normal footprint is fixed both on the medial and lateral sides of the tuberosity. So it makes sense that we would want to reconstitute that anatomy. Meyer showed that the single row repair reproduced 46% of the footprint, whereas a double row repair reproduced 100%. There are other anatomic considerations as well. The rotator cable crescent complex being one. We looked at this in an anatomic study and found that the cable attachments were the most important, strongest attachments at resisting failure of rotator cuff. This led to this suspension bridge modeling for rotator cuff tears. And I think because of that, I like to reinforce these cable attachments with an extra cinch stitch in all cases. Biomechanically. We know that double row minimizes tendon to bone interface motion. We know that double row improves tendon to bone contact during internal and external rotation. We know that the linked double row seals off the healing zone from synovial fluid, which I think is quite important, and that these double row bridging constructs are self reinforcing systems, much like a Chinese finger trap, where the harder you pull, the tighter the grip becomes. And this happens in the rotator cuff for a couple of reasons. You have increasing compressive and compressive and frictional forces. As the muscle contracts and displacement occurs, and you get a wedge effect of the tendon being wedged between suture and bone. So what if the tendon is poor quality or short or deficient? What do you do then? Well, we've been using the anchor based load sharing ripstop. And what this does, it has a knotless FiberTape that's fixed laterally. And then that acts as a ripstop for sutures that go over that. So it basically converts what would have been a single row repair into a linked double row repair. That's self reinforcing. We've looked at this in the lab, and we found that the load to failure for the load sharing ripstop is 1.7 times higher than with the single row repair. So how does this work? Well, we know that cables are the most efficient way to support a load over a long span. We talked about the suspension bridge modeling as being an example of that. And then how that there is an anatomic basis for that. If you look at the cable if you look at these cable systems, there are two types of cable supported bridges. One is a suspension bridge, but the other one is a cable stayed bridge. And if you look at the modeling of this load sharing ripstop, it's basically the same mechanics as this cable stayed bridge, which is a self reinforcing construct. So if you use these tried and true biomechanical modeling, I think that you're going to be safest staying with things that have worked in other settings. So I think today is gold standard for a pair of crescent shaped cuff tears. Is the SpeedBridge linked double row repair? These are some SOS diagrams that just show that the recovery is basically the same between knotted or knotless, but the knotless saves significant amount of time. There are some enhancements to the SpeedBridge this dog ear reduction cinch loop, which also reinforces the cable attachments. And then if then if your if your tissue is suspect then doing this medial double pulley double mattress it seals off the healing zone and reinforces things medially. So the biomechanics of Nautilus lateral fixation, we're basically we know there's friction between the anchor and the bone. But there's also what we call cable friction around the eyelet of the anchor, which I think is even more important. And as with many things in Texas, there are lessons from the ranch. We know that if you have a lead rope on a horse and you try to restrain it, there's no way you can do it because he's stronger than the man. But the if you're able to get a wrap of that rope around a post, you can significantly decrease the amount of force you have to put the old cowboys near this. They knew that if you get one wrap around a post, it would take about one fifth of the force to restrain that horse. And so the same thing happens. You have a cable friction that develops with the SwiveLock eyelet and FiberTape. So you have that cable friction that's That significantly inhibits lateral failure. What about medial fixation? There's this concept that you heard described earlier from Tom Dooney this cross anchor knotless self-reinforcing tensional loop fixation that you have with knotless SutureTak knotless corkscrews, and now with a knotless SwiveLock where you're taking the working suture of one anchor and shuttling it through the splice of the other anchor, and vice versa. You've seen this diagram, this video, many times just how these anchors work, how the splice works. This is a study that we just published in the Arthroscopy Journal in November, looking at Remplissage, which basically ends up being like a posterior pair using interconnected knotless anchors and the superior biomechanical properties. So basically you have the two anchors, much as you would have with a posterior pair, and you interconnect the splices of one anchor to the other. And we compared that to the standard knotted double pulley technique to the knotless double pulley. We cycle it 100 cycles pull the failure. And what we found was with cyclic loading, there wasn't any failure in either group. But when you look at the single pull to failure, the yield load for the Nautilus was almost twice what the nodded was. And. And if you look at the mean load to to failure, the the Nautilus was about 40% higher than the nodded. So in conclusion, the medial nautilus fixation by interconnected, self-reinforcing tensional loops is significantly stronger than the knotted fixation. And the editorial comment from Doctor Pedowitz on this was in total agreement. So I was pleased by that. Techniques. Here's a Nautilus post repair using Nautilus SutureTak. You see here a significant pasta lesion. And we're going to use a percutaneous insertion kit. We're going to try to puncture that capsule there as well. So we bring the tendinous layer and the on the capsule layer down. I think that's important. You want to get the capsule attached immediately. So this will be a knotless SutureTak going in here. You can punch that hole. So you compress the bone rather than drilling it and taking out. Now that we have the knotless Corkscrew, this is actually if the bone is suspect at all, you'd want to use the threaded anchor here, the Corkscrew rather than the Knotless SutureTak. This just happens to be the Knotless SutureTak here. So we have the two anchors, one at the front and one at the back of the footprint. And then we're going to do cross anchor threading here. We'll take the working suture from the one anchor and thread it through the splice of the other anchor. And then we'll then we'll reverse that. Take the working suture of the second anchor, thread it through the splice of the first anchor. And then you're going to cinch these down by cyclically reciprocally pulling on pulling on them. You see these? You bring them down to where they're close, but not tight. And then you tighten them. Once both splices have been, have been formed. And you see how this brings it down very nicely. And then you can fix this laterally. So then you turn this into a linked double row Nautilus type of configuration. So this is that Nautilus SwiveLock where you can do a nautilus medial and lateral rows. And this just is a the foam bone demonstration of it, where again you're doing the cross threading one anchor through the splice of the other anchor. You get them both down most of the way and then you cyclically tighten them down. And then you can use the tension loop from your lateral anchor to do that dog ear reduction. Now this is using the Nautilus SwiveLock immediately with attentional loops. This is on a cadaver. So we passed all the sutures. We've just shuttled them through two spots in the rotator cuff, again passing the working suture through the splice of one anchor, through the splice of the other anchor, and vice versa. You see how they're not all totally cinched down yet, but then we're going to pull on those reciprocally and we'll indent the tissue there. And you see looking under there through the lateral side, how you have great apposition of the tendon to the bone. Now we'll use that same anchor laterally to take the FiberTape out of it first. But now we have our tensional loop construct here that we can use to reduce the dog ear. And so this is done with for Nautilus SwiveLock anchors. Thank you.

Alan M. Hirahara, MD, FRCSC, (Sacramento, CA) demonstrates a PASTA rotator cuff repair using a knotless suture construct and discusses postoperative rehabilitation. For this repair, Dr. Hirahara uses the 3.9 mm Knotless Corkscrew® suture anchors with a partially threaded anchor body.

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PASTA Repair Using the 3.9 mm Knotless Corkscrew® Anchor

Good morning. My name is Alan Hirahara. I'm here to talk about pasta lesions. We've created a pasta lesion on the anterior aspect of the supraspinatus. It's approximately 5 or 6mm in depth, and it's about a centimeter in anterior posterior width. For this procedure, we're going to do a knotless pasta bridge technique to try to bring this tissue back down and repair it. So we're going to start with our spinal needle first. What we want to do is we want to get the spinal needle to come through pretty much right at the anterior aspect of your tear. As you'll notice, we can easily change our position of where we want to be and at what point we want to come through to be able to ideally find the ideal location of our entry point. This is non damaging to the tissues. Once we have identified our location for our entry point of our anchor and our sutures, where we're going to eventually have them come through, we can replace that spinal needle with a nitinol wire. I'll then make a small percutaneous incision. Then follow it up with a dilator. Once the dilator is in place, we can remove our nitinol wire. Now we can replace it with a half pipe spear. We'll now go ahead and turn the scoop towards us. The half pipe spear is very important because it doesn't open up a very large socket through the rotator cuff tissue. It allows it to minimize the cut through that will make into the actual tissue. It's only half a pipe. Therefore, it's going to be easier to work with. Won't damage the tissue easily. Allows us to get in and access to our location. Once this is done, we'll be able to punch our socket. Once this is down, we'll want to punch this down just to the laser line. At that point, we'll be able to place our anchor. This is a 3.9 knotless Corkscrew anchor, so it screws right in. Bring it right to the laser line and done. At this point we take off the black rubber gasket. Just pull straight back and that part is done. That's our first anchor in place. Now we're going to place our next anchor just posteriorly. So again we're going to find our location of where we want to enter. When it comes in just at the edge of the leading of the good tissue, I'll go ahead and place my punch so that it's through the tissue. I'll then go and reset my spear to where I want to place my anchor, and then we'll just pound it in to the laser line. At this point, you now see the two anchors in place. You have the anterior anchor, and you have the posterior anchor that spans the gap of the actual defect of that pasta lesion. Now we're going to load our passport cannula onto our inserter. [00:03:33] And one of the OsteoAuger. So now that we have both anchors and sutures passed, we simply have to go to one of the anchors and take the passing looped suture. And we'll pull that out. We'll take the actual repair suture From the other anchor. And pull that out. This will allow us to place the repair suture from one anchor into the loop of the other. I'm folding over on the repair suture, the end, so that it reaches just to the end of the white portion of the suture. This will allow for appropriate passage through the anchor. We now simply have to pull on the corresponding passing suture and bring our repair suture into the anchor. And with a few small tugs, get it to pass through. And we do not want to tighten this yet. We just want to bring it down so that it's in position, ready to be used. And we'll leave a small loop for now in it just like that. So we have not tightened that down. We've just kept it loose. So now we will simply take the passing suture from this end with the loop. Once again, we just simply pull on our passing suture end. Bring that loop in tug, tug. Allow it to pass through easily, and we'll just simply bring that down to a tension not overly tight yet. Just like that, it's now loose enough for our construct is now ready to go. Now we're going to have to do is go back to the joint and watch it. Tension on its own. Typically I would just go ahead and tighten at this point. I trust in this construct. I would go ahead and tighten this down as best as I wanted, and then I would go ahead and place my lateral anchor. However, if there's any concern, once you've tightened it, you can easily go to the joint and continue to tighten it as you've lost nothing at this point. For demonstration purposes, we'll go ahead and go inside and watch it be tightened from the inside. We can easily see that the construct has been made. All we have to do now is simply pull on the sutures to tighten the construct. And you can see that brought the brought the tissue down to our defect quite nicely. And I can see that tissue is down very nicely. It cannot be looked back up at all. If there's any concerns, you can simply just retighten it at this point and keep pulling the sutures to the tension that you want. One option is to go ahead and cut off the sutures at this point. Another one is to take them laterally to a SwiveLock to create a double row construct. So at this point, we'll go ahead and regrab our sutures and pull them through our cannula. We'll attach a SwiveLock to them. All right. So now that we've placed our lateral SwiveLock, create a double row construct. The surgery is finished. So at this point the rehab is quite simple. This can be treated as a standard cuff repair. However it's a very strong construct. Therefore it can actually be the type of situation where you can get range of motion easily. We begin range of motion passively within 5 to 7 days. We have our see our therapist within 5 to 7 days we do do active assisted by about four weeks. And we'll start getting full strengthening creation by about 2 to 3 months. Back to sports. We tell patients 4 to 6 months. The key to this is getting range of motion back. This does not create stiffness because you try not to lose the tissue. You also try not to go too far medial as you go posterior. So as you go posterior into infraspinatus you wanna make sure you respect the bare spot. You don't take it all the way to the articular cartilage. When you're in supraspinatus, going to the articular cartilage margin is appropriate because that's where the native tissue comes from. If you try to utilize the tissue too much posteriorly, you will lose abduction external rotation. And that is going to be a main concern. So respecting the anatomy and trying to put it back where it was is the key to this and avoiding any complications. Post-operatively.

Alan M. Hirahara, MD, (Sacramento, CA) describes the biomechanical and technique pearls utilizing the latest Arthrex® products available in the US for the SCR procedure. He discusses the positive patient results and clinical outcomes his patients are experiencing as an effective treatment alternative for irreparable rotator cuff tears.

Superior Capsular Reconstruction (SCR): Biomechanics, Technique and Early Results

Hi. Thank you very much. We're going to talk now about the biomechanics technique and some early results for the US. Basically that's exactly what we're talking about irreparable rotator cuff tears. So we're not talking about cuff tear arthropathy. We're talking about so massive irreparable just cuff tears. So the big question always is like, well, okay, here's a patient, 59 years old, right hand dominant female. She's a schoolteacher. She's had three cuff repairs that have failed, and she can't write on the board. But she's 59 and she has some very minimal arthritic changes. Activat motion for elevation 90, strength three -5 to 5. What do we do? Well, classically, with this kind of a patient, there's not a lot we can do. She's already had multiple attempts. Repair. She's got big bone defects. Retraction. Back to the glenoid in the. In the past we talked about debridement, partial repairs, revision cuff dorsi transfer bridging and of course more recently reverse arthroplasty. But this is a hard problem. This is a is a very hard case. So the options we've already listed but more traditionally reverse arthroplasty more recently is not something that is a very good option for this patient. This person still young, they have a lot of, you know, still good cartilage left, just a massive cuff defect. So since Doctor Malhotra presented on the supercapacitor construction as a new biologic option, this has been more alluring. Potential option that we should be looking at to maybe fix some of these patients as an intermediary step. So the disadvantage reverse shoulder, as we all know, is that it's been subject to overuse. It's too easily seen as the solution for untreatable other shoulder pathologies. Challenging surgical technique. It requires extensive training, experience limits availability, and it's a wide range of complications. And let's remember it is an arthroplasty. It's going to have a limited lifespan. So bridging versus SCR. We've seen that bridging has had its own complications and problems and doesn't necessarily work with graph patching, and this newer fascia Lata SutureCast reconstruction has shown excellent outcomes with Doctor Malhotra's work, so he's already presented this 24 shoulders over two years, showing excellent acromial distance from 4.6 to 8.7 on average, and the x axis score is going from 24 up to 93 and only a 17% complication rate. He's shown us that you can reproduce the same motion by having an intact capsule, by recreating that superior graft, and then you get the same kind of motion in glenohumeral movement. His fascia Lata, however, does take a lot of extra surgery. You have to go and take a large graft, and he's now using up to about 6 to 8mm of graft from fascia Lata, which is quite large, to enable to have enough stability and strength of that graft. So that's kind of brought us to the idea of maybe we should be using an ECM patch as another alternative. We know that the ECM patches have been shown biomechanically to be quite strong, and that dermal grafts have a superior suture retention over SCS and BM patches. But we know also with some of the other grafts available today that they do contain significant amounts of DNA, which have given us some kind of reactions. However, with ArthroFLEX it has a high suture retention, high ultimate load, but it has the lowest DNA residual, meaning it has the lowest chance of reactions. That's because of the MatrACELL process. This processing was originally used for heart valves, and it has a proven biomechanical strength and is able to take care and remove a large amount of DNA and protein to allow this not to be reactive, and the ArthroFLEX safety record has been evident. 11,000 over 11,000 graphs have been sold, and the complaint rate has been less than 0.0 5%, and all the complaints have been packaging related, not related to the implant itself. So in vivo studies have been showing that these graphs actually do incorporate. We do see actually revascularization post implantation. Well, that brings us to the SCR. We know that if we go ahead and use this ArthroFLEX graph, we have a very strong construct. We've now gone ahead and looked at a potential pasta bridge construct immediately using post margin convergence. As Doctor Mahajan has taught us, as well as a SpeedBridge construct laterally. New options. Recently we've been looking at doing a double surgeon's knot immediately, in case people are worried about putting that medial anchor along the glenoid neck. And we've also been using a double pulley system, both medially and laterally, to be able to quickly and more effectively introduce the graph without getting graft twisting or suture impingement or knotting. We then took a look at the biomechanical comparison. We took the fascial lot and we doubled it. And we found that the failure rate, the failure strength and the pullout strength was actually only about 180 Newtons. We then took a look at an ArthroFLEX 3.5mm graft using the same construct. And it was significantly different. And the failure rate was actually 550 Newtons. And we used a double surgeon's knot. It was only down to 480. So it's a very strong construct. So here's what we're looking at now with a very simple technique, we can easily measure the intra-articular distance of what we need. We're able to actually place our anchors specifically in the glenoid and measure between them. We can then cut our graft to specific size, and once the anchors are in place, we can actually then go ahead and punch specific holes and put them just like we have with our augmentation graphs in a specific manner, so that the sutures will go exactly in the right place. We want it. And now that we're starting to place our anchors both medially and laterally. Prior to graph placement, we're able to punch all the holes simultaneously, and so that the graph will introduce and go in exactly where it's supposed to go. Using these double pulley systems helps allow us and ensure the graft will go to the direct placement exactly where it should be. And by pulling the sutures, it sets the graft exactly in the position by pre punching the holes. There's not going to be any dog ears or any excess graft that's going to be loose. We do this both medially and laterally. We complete both the medial pasta bridge as well as the lateral SpeedBridge. And it makes this a very simple technique that's actually not very difficult and quite reliable to do. And this is the finished product. And posteriorly, I will also punch holes to have easy passage of the sutures for that posterior margin convergence. Here's that same case one. You can see that she has only a distance of two millimeters. I showed you already what she looked like inside. This was before. Afterwards. Here's what it looks like from the subacromial space with a graft in place. And now, inside the joint, looking up, you can see it actually looks very similar to a rotator cuff. Post-operatively. She went from 2.0 up to an 8.4 chromosomal distance. You can see this is what a normal rotator cuff would look like in MRI. This is what she looked like. Preoperatively. And this is what she looked like. Post-operatively. What was very most interesting is that I saw exactly what Doctor Mahatta showed us. We're seeing that these patients are having very good range of motion, post-operatively and very quickly. And there's been a huge diminishment in pain. Here's just the last case is another case that actually had a similar type of situation with a massive cuff tear. The interesting thing is that one month post op, he came back and told me that a week after surgery he had fallen. Great. And you've seen you've had other shoulder surgeries. How does this compare to those? Oh. I've recovered so much faster. It's hard to believe. And the pain level throughout has been relatively low. And this is right. And this is right. After he fell, he fell right on that arm and had a big elbow, big grapefruit on his elbow. But his shoulder was fine. So he just came back a few weeks ago and says, I have another problem. I was lifting 2 pound weights and I felt something pop. I'm like, great. Get on the table. Let's check this out. So I went ahead and I pulled his ultrasound image from one month. And from one month after his fall, his graft was intact and present. But more importantly, now, just literally a week ago, this is now his ultrasound. The graft is fully intact and it's attached very nicely to the tuberosity. And you can see, in fact, the graft is even thickened up and is more apparent than before. We have an MRI pending. But what's more interesting is it looks like on ultrasound he in fact tore his infraspinatus. He didn't tear his graft. Now hold on to that and we'll come back to that at some other point down the road when I get that MRI result. But that's what we're looking like. So the interesting thing is we do the comparison. We can see that the fascia Lata allograft has a pullout strength of 180. The ArthroFLEX 550. The just the six patients I've had over the past year have had very similar outcomes to Doctor Mahada and the SOS data. If we compare it the visual analog scale of reverse to SCR. Now, granted, the numbers are very small, but it's already showing very good outcomes, both with Vas a as well as with ASCs. And more importantly, with the rehab, we're finding that we can be very different with the rehab as well, because with the rotator cuff repair as the massive cuff tear, we have to be very cautious about protecting the integrity of the repair and being cautious about beginning rehab slowly. But what's more important is that with the SCR, the goal here is, in fact, not to actually protect the recovery because it's so strong in how good the fixation is. So we can have a goal to mobilize it. And because no tissue is repaired, so can we have faster and get them moving faster. It's got an interesting application for the future and interesting possibilities. Thank you.

Fasszange für Rotatorenmanschetten

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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Knotless Medial and Lateral Row Rotator Cuff Repair

Superior Capsular Reconstruction (SCR): Biomechanics, Technique and Early Results

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PASTA Repair Using the 3.9 mm Knotless Corkscrew® Anchor

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Bursal Acromial Reconstruction Case Presentation

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