Arthroscopic or Mini-open Rotator Cuff Repair The Learning Curve

Description: 16th Annual Meeting San Diego Shoulder Arthroscopy Course Stephen C. Weber, M.D.
I. Cuff repair options:
A. Open repair/open acromioplasty. Good results reported by Ellman, Cofield, and numerous others. Anticipate about an 85% success rate.
B. Arthroscopic debridement. Good initial results reported by Ellman and Esch for full thickness tears. Early results of debridement of small to moderate size tears very equivalent to open repair.
C. Mini open repair. Multiple studies presented in the early 90’s of retrospec- tive reviews of arthroscopic evaluation and acromioplasty followed by open repair through a deltoid splitting incision. Appeared to combine advantages of open repair (direct visualization of repair, palpation of acromioplasty, long term success of repair) with arthroscopic visualization and decreased morbidity.
D. All arthroscopic repair. Intellectually attractive procedure which is perceived by virtually all patients and many surgeons to be superior to open procedures. Early retrospective series by Snyder, Wolf, Tippett, and others demonstrated that skilled surgeons could apply these new techniques with one to two year results comparable to prior series of open repair.