Circumferential Rotator Cuff Repair With the N+4 Portal, Subclavian Portal, and High Posteromedial Portal Keith D. Nord, M.D., M.S., Maher W. Khan, M.D.,

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Presentation transcript:

Circumferential Rotator Cuff Repair With the N+4 Portal, Subclavian Portal, and High Posteromedial Portal Keith D. Nord, M.D., M.S., Maher W. Khan, M.D., Garth B. Wright, M.D., Jonathon B. Taylor, B.S. Arthroscopy Techniques Volume 4, Issue 1, Pages e7-e11 (February 2015) DOI: 10.1016/j.eats.2014.09.009 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 Left shoulder viewed in the beach-chair orientation showing suture retrieval through the subclavian portal with the Penetrator suture retriever (Arthrex) as seen from the posterior arthroscopic viewing portal. Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 One hundred fifteen rotator cuff repairs were performed by the primary author (K.D.N.) using various portals between July 1, 2012, and July 31, 2013. (Post, posteromedial portal; Sub, subclavian portal.) Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Left shoulder viewed in the beach-chair orientation through the posterior portal while surgery was performed in the lateral decubitus position showing the N+4 portal used for suture passage. Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 Left shoulder viewed in the beach-chair orientation showing suture passage through the high posteromedial portal for rotator cuff repair as viewed arthroscopically. The cuff is being lifted with a rotator cuff grasper (Arthrex) while the Penetrator passes through the rotator cuff. Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 Digital rendering of a right shoulder depicting the neurovascular structures at risk during suture passage using the new N+4 portal for rotator cuff repair as viewed posteriorly. (AN, axillary nerve; IS, infraspinatus; SA, suprascapular artery; SN, suprascapular nerve; SS, supraspinatus; TM, teres minor.) Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 6 Left shoulder in the lateral decubitus position showing the N+4 portal. The measurements are 4 cm lateral to the traditional Neviaser portal and 1 cm anterior to the spine of the scapula. Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 7 Left shoulder in the beach-chair orientation viewed arthroscopically from the posterior portal showing a hemispherical rotator cuff repair achieved with the use of the N+4, subclavian, and high posteromedial portals. (HH, humeral head.) Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 8 Cadaveric radiographic image of a right shoulder in the beach-chair position showing the N+4 portal with a 20° angle of approach from the sagittal plane for a rotator cuff repair. Arthroscopy Techniques 2015 4, e7-e11DOI: (10.1016/j.eats.2014.09.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions