Margin Convergence - successful rotator cuff repair 2 years after traumatic injury

This case illustrates that margin convergence can provide enough length for repair of large chronic traumatic retracted rotator cuff tears. In this scenario two tendons were involved in the tear, the supraspinatus and infraspinatus, the tear was 2 years old. As seen on the MRI there was Grade 2 fatty infiltration of the infraspinatus. The torn rotator cuff was reattached with an anchor to the footprint of the rotator cuff using the sutures limbs that were placed through the cuff for the margin convergence.

Reverse total shoulder arthroplasty for irreparable rotator cuff tear for an elderly patient

The "moonlight" period of the shoulder hemiarthroplasty. Revision to total shoulder replacement

In the following case a revision of a stiff painful hemiarthroplasty to an anatomic total shoulder replacement is demonstrated. There was a "moonlight" period of several years of improvement in pain after the index hemiarthroplasty which was followed by progressive stiffness and pain. For that reason, a biopsy using the arthroscope was performed prior to the conversion to the anatomic total shoulder prosthesis which did not indicate any signs of infection after holding the cultures for 21 days. The biopsy is helpful in those situations, it is a fast and relatively benign procedure and it does answer the question of p. acnes infection. The patient had a pain free shoulder after the revision surgery. Post op and preop images as well as arthroscopic imaging and preop MRI arthrogram done at an outside institution are demonstrated.

Arthroscopic picture shows the loss of the cartilage on the glenoid side.

Iliac crest bone grafting of the glenoid to address anterior subluxation after shoulder hemi-arthoplasty

This case illustrates the difficulties encountered in shoulder arthroplasty for the patient who is below 50 years of age. There is a history of prior bankart repair for anterior shoulder instability without bone loss. The anchors were prominent and the patient referred to me for reconstruction. X-rays below indicate the slight anterior subluxation of the humeral head which was persisted even after the hemi-arthoplasty. A second operation was required to reconstruct the anterior glenoid using iliac crest bone graft and address the subluxation which was causing persistent pain. The patient was pain free after the correction of the subluxation. The subscapularis repair was intact during the entire process which made things easier.

Anterior subluxation.

ICBG of the anterior inferior glenoid