DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left shoulder rotator cuff tear.
POSTOPERATIVE DIAGNOSES:
1. Left shoulder rotator cuff tear.
2. Acromioclavicular joint osteolysis.
OPERATION PERFORMED:
1. Arthroscopic repair/reconstruction of large rotator cuff tear.
2. Distal claviculectomy.
3. Subacromial bursectomy.
4. Coracoacromial ligament release and resection.
5. Arthroscopically guided insertion of intraarticular epidural pain catheter.
SURGEON: John Doe, MD
SEDATION: General, scalene block, intraarticular epidural pain catheter.
OPERATIVE FINDINGS: Large degloving rotator cuffs tear from anteriorly, extending back into the infraspinatus with some minor retraction. Intact biceps. Intact glenohumeral articulation. Deterioration of distal clavicle.
INDICATIONS FOR OPERATION: This is a (XX)-year-old with pain and disability from rotator cuff tear. The patient is in now for elective rotator cuff repair. All the risks were explained preoperatively and informed consent was given.
DESCRIPTION OF OPERATION: The patient was transferred to the operating suite in good and stable condition, was placed supine on the operating table and underwent uncomplicated scalene block and general endotracheal intubation in the sitting position. The left shoulder and upper extremity were prepped and draped in the usual sterile fashion utilizing Betadine. The anatomic margins of the shoulder were mapped out with a marking pen, and 2 cm inferomedial to the posterolateral margin of the acromion, a small stab incision was made followed by the blunt trocar. The outflow cannula was inserted through the AC joint. The glenohumeral articulation was normal. The biceps was intact.
Moving to the subacromial space, there was a large rotator cuff tear noted. The rotator cuff was repaired arthroscopically with hand and motorized instruments back to smooth, stable, healthy margins. Moving to the subacromial space, the mediolateral portal was developed midway between the anterolateral and posterolateral margin of the acromion. A small stab incision was made followed by the full radius resector. A thorough subacromial bursectomy was performed. The coracoacromial ligament was taken off the anterior acromion with electrocautery and fully resected back to its origin on the coracoid arthroscopically. With the scope in the mediolateral portal and the bur in the posterior portal, the anterior 2.5 to 3 cm of hooked type III acromion was converted to a type I. There was osteolytic deterioration of the distal clavicle. The distal 5 to 10 mm of distal clavicle was resected arthroscopically. Thorough debridement of the periosteal sleeve was performed to prevent any new bone formation.
Further preparation of the rotator cuff was then performed. Decortication was performed with a high speed bur juxtaposed to the posterior articular margin. Superior to the mid lateral portal, a small stab incision was made and multiple bioabsorbable suture anchors were placed with excellent purchase noted in the subcortical bone and simple interrupted 2-0 FiberWire arthroscopic locking sutures were placed to advance the rotator cuff anatomically. A firm repair was performed from anterior to posterior. Care was taken not to involve the biceps tendon anteriorly. Copious irrigation with normal saline was performed. A 14 gauge angiocatheter was guided into the anterolateral aspect. An intraarticular pain catheter was threaded in place and secured down with a Tegaderm dressing.
Interrupted #2-0 Vicryl sutures were used to approximate subcutaneous and dermis. The skin was augmented with Steri-Strips and abduction arthrosis and UltraSling immobilizer was placed on the table. Adaptic, 4 x 4s, and paper tape dressing were applied. The patient tolerated the procedure well and left the operating room breathing spontaneously and in a good stable condition with an intact neurovascular exam and a persistent scalene block still in place.
