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 Wysłany: Pi± 7:06, 10 Gru 2010 Temat postu: Rotator Cuff Repair - An Endless Pursuit to Improv |
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Our first priority is to provide patients with a comprehensive diagnosis, which can often mean that the patient has another factor alongside the rotator cuff tear that may have contributed to persistent pain, weakness, or failure to heal-such as: a pinched nerve in the shoulder, a frozen shoulder, or an unstable shoulder, as well as many others. Along with offering a comprehensive approach to arthroscopic management of any associated pathology,air jordan VII, we have also been pioneers in providing innovative techniques that are not available elsewhere. A lot of work has been done on increasing the strength of rotator cuff repairs in an effort to improve results. Unfortunately, without honoring the anatomy of the rotator cuff and recognizing the principles involved in the function of the rotator cuff, many of these techniques that are very strong in the cadaver lab,Nike Obama, have resulted in more worrisome clinical patterns of repair failure.
While fully adhering to the anatomic and physiologic principles of rotator cuff repair we originally outlined, we have also worked tirelessly to find ways to improve the strength of the rotator cuff repair to provide patients an extra safety net and also to find ways to reinforce the tissue for those patients with rotator cuff tissue of questionable quality. For instance, a massive tear in a patient who has had several previously failed repairs typically means the ability of the tendon to heal is questionable.
Because the majority of patients with these kind of tears we treat here at The Shoulder Center have not had satisfactory results from previous rotator cuff repair elsewhere, we are always looking at ways to improve the results of rotator cuff repair. Along with our very popular and scientifically based surgical repair protocol, we are also constantly working to improve these results,supra vaider black thumbprint, even in those patients traditionally thought to have no hope of success. These techniques have allowed us to offer hope to patients with large or massive tears, as well as those with other risk factors that may limit the results with other surgical techniques-diabetes, smoking, prior surgery,mbt lami gray, obesity, and patients older than 60 years of age.
Dr. Ernest Amory Codman,vibram five fingers sprint blue gray shoes, widely considered the father of evidence-based medicine, first championed rotator cuff repair in the early 20th century. He is considered to have performed the first reported rotator cuff repair in the English literature in 1909 after observing treatment for this disease and studying it in detail as a medical student in Germany. Many of the techniques and principles of rotator cuff repair remained relatively unchanged for the remainder of the 20th century.
Arthroscopy of the shoulder, starting with arthroscopic acromioplasty,mbt chapa gtx ebony, widely credited to Dr. Harvard Ellman who reported his results in 1987, gradually ushered in a sea change of interest and understanding in shoulder injuries. Coinciding with the introduction of the suture anchor and arthroscopic techniques, Dr. Eugene Wolf performed first arthroscopic rotator cuff repair with suture anchors in 1990. Since then a flurry of activity has occurred with an explosion in techniques and implants to improve the results.
We have been performing an all-arthroscopic approach for graft reinforcement of these types of repairs for several years. While the results in our hands have been very encouraging, the techniques are very difficult for other surgeons to learn and master, severely limiting these techniques to just a few highly specialized destination centers for shoulder surgery around the world. That may now be changing with a novel technique we recently described which should make it easier for surgeons to offer better results to more patients. Building on our original tension band anatomic repair, we have used recently introduced technology to allow us to create a novel technique that not only improves the strength of the rotator cuff repair, but also creates an easy and reproducible method to reinforce the repair with a biologic reinforcement graft to improve the healing rates and results for even the most difficult patients.
Rotator cuff tears are very common and unfortunately failed repairs are also very common. Do your homework and find a shoulder specialist that has experience with the most advanced techniques for rotator cuff repair.
Unfortunately, despite the significant advances that have been made in the treatment of these tears, the results and healing rates still vary widely with reported failure rates ranging from 11-94%. Among the many reasons for this, surgeon skill and experience is often cited as one of the most important variables involved. Many other factors including patient related factors such as smoking history, age, size of tear, quality of tissue and compliance (meaning following the restrictions and directions required after surgery to allow healing of the repaired tissue) can also play a part.
Ideally, we would like to have the ability to reinforce the patient's own tissue so that the compromised tissue is supported during the critical healing phase while also creating a template for replacement of the supporting tissue with the patient's own tissue to create a stronger more normal tendon at the end of the healing cycle. There are several promising grafts available currently with excellent biocompatibility and certainly others to follow as the age of biologics continues to advance in shoulder surgery. We have outlined some of these emerging technologies at our web site. The other part that has been considered impossible by many surgeons is a reliable and durable technique to reinforce these repairs without an incision meaning an all-arthroscopic approach. |
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