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Archives of Orthopaedic and Trauma Surgery

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25.07.2020 | Arthroscopy and Sports Medicine

Arthroscopic transosseous rotator cuff repair: how to avoid damaging the axillary nerve—a cadaveric study

verfasst von: José Antonio Blas-Dobón, Luis Aguilella, Daniel Montaner-Alonso, Maria Morales-Suárez-Varela

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 11/2020

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Abstract

Introduction

Arthroscopic transosseous rotator cuff repair can be performed with an external guide, although the proximity to the axillary nerve raises safety concerns. The aim of this study is to determine the safety of different drilling angles regarding the axillary nerve.

Materials and methods

We performed a bone tunnel in the greater tuberosity in 17 fresh frozen shoulders, using an external guide at four different angles: 40°, 50°, 60°, and 70°. At each angle, we measured the distance between the drill and the axillary nerve, the distance from the acromion to the skin incision point, and the perimeter of the arm at the axilla.

Results

The distance to the axillary nerve was safe with the guide at an angle of 40°, 50° and 60°, but not at 70° (p = 0.001). We found significant differences between all four angles (p < 0.05). Regression analysis demonstrated the influence of the guide angle in all measurements assessed (p < 0.001). There was no association between the measurements taken and the axillary perimeter (p > 0.5).

Conclusions

Arthroscopic transosseous rotator cuff repair with an external guide does not pose a risk for the axillary nerve using angles of 60° or less.

Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ (2002) Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 18(5):519–526. https://doi.org/10.1053/jars.2002.32930CrossRefPubMed

Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS (2005) Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med 33(8):1154–1159. https://doi.org/10.1177/0363546504273053CrossRefPubMed

Sano H, Yamashita T, Wakabayashi I, Itoi E (2007) Stress distribution in the supraspinatus tendon after tendon repair: suture anchors versus transosseous suture fixation. Am J Sports Med 35(4):542–546. https://doi.org/10.1177/0363546506296310CrossRefPubMed

Ahmad CS, Stewart AM, Izquierdo R, Bigliani LU (2005) Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques. Am J Sports Med 33(11):1667–1671. https://doi.org/10.1177/0363546505278252CrossRefPubMed

Bronsnick D, Pastor A, Peresada D, Amirouche F, Solitro GF, Goldberg BA (2019) Is Arthroscopic transosseous rotator cuff repair strength dependent on the tunnel angle? Orthop J Sports Med. https://doi.org/10.1177/2325967119848667CrossRefPubMedPubMedCentral

Garrigues GE, Lazarus MD (2012) Arthroscopic bone tunnel augmentation for rotator cuff repair. Orthopedics 35(5):392–397. https://doi.org/10.3928/01477447-20120426-04CrossRefPubMed

Pietschmann MF, Frohlich V, Ficklscherer A, Hausdorf J, Utzschneider S, Jansson V, Muller PE (2008) Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 16(5):504–510. https://doi.org/10.1007/s00167-007-0460-3CrossRefPubMed

Urita A, Funakoshi T, Horie T, Nishida M, Iwasaki N (2017) Difference in vascular patterns between transosseous-equivalent and transosseous rotator cuff repair. J Shoulder Elb Surg 26(1):149–156. https://doi.org/10.1016/j.jse.2016.06.010CrossRef

Black EM, Austin LS, Narzikul A, Seidl AJ, Martens K, Lazarus MD (2016) Comparison of implant cost and surgical time in arthroscopic transosseous and transosseous equivalent rotator cuff repair. J Shoulder Elbow Surg 25(9):1449–1456. https://doi.org/10.1016/j.jse.2016.01.003CrossRefPubMed

10.

Seidl AJ, Lombardi NJ, Lazarus MD, Black EM, Maltenfort MG, Pepe MD, Austin LS (2016) Arthroscopic transosseous and transosseous-equivalent rotator cuff repair: an analysis of cost, operative time, and clinical outcomes. Am J Orthop 45(7):E415–E420PubMed

11.

Black EM, Lin A, Srikumaran U, Jain N, Freehill MT (2015) Arthroscopic transosseous rotator cuff repair: technical note, outcomes, and complications. Orthopedics 38(5):e352–e358. https://doi.org/10.3928/01477447-20150504-50CrossRefPubMedPubMedCentral

12.

Kuroda S, Ishige N, Mikasa M (2013) Advantages of arthroscopic transosseous suture repair of the rotator cuff without the use of anchors. Clin Orthop Relat Res 471(11):3514–3522. https://doi.org/10.1007/s11999-013-3148-7CrossRefPubMedPubMedCentral

13.

Cicak N, Klobucar H, Bicanic G, Trsek D (2006) Arthroscopic transosseous suture anchor technique for rotator cuff repairs. Arthroscopy 22(5):561–566. https://doi.org/10.1016/j.arthro.2005.07.029CrossRef

14.

Fox MP, Auffarth A, Tauber M, Hartmann A, Resch H (2008) A novel transosseous button technique for rotator cuff repair. Arthroscopy 24(9):1074–1077. https://doi.org/10.1016/j.arthro.2008.02.014CrossRefPubMed

15.

Kim K-C, Rhee K-J, Shin H-D, Kim Y-M (2008) Arthroscopic transosseous rotator cuff repair. Orthopedics 31(4):327–330. https://doi.org/10.3928/01477447-20080401-19CrossRefPubMed

16.

Shea KP, Jennings JE (1998) Arthroscopic rotator cuff repair using a transhumeral approach to fixation. Arthroscopy 14(1):118–122CrossRef

17.

Garofalo R, Castagna A, Borroni M, Krishnan SG (2012) Arthroscopic transosseous (anchorless) rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 20(6):1031–1035. https://doi.org/10.1007/s00167-011-1725-4CrossRefPubMed

18.

Apaydin N, Tubbs RS, Loukas M, Duparc F (2010) Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat 32(3):193–201. https://doi.org/10.1007/s00276-009-0594-8CrossRefPubMed

19.

Rastogi P, Stewart DA, Lawson RD, Tremblay DM, Smith BJ, Tonkin MA (2018) Cadaveric dissection of the axillary nerve: an investigation of extra-muscular and intra-muscular branching patterns. J Hand Surg Asian Pac 23(4):533–538. https://doi.org/10.1142/s2424835518500546CrossRef

20.

Gupta H, Mishra P, Kataria H, Jain V, Tyagi AR, Mahajan H, Upadhyay AD (2018) Optimal angle of the bone tunnel for avoiding axillary nerve injuries during arthroscopic transosseous rotator cuff repair: a magnetic resonance imaging-based simulation study. Orthop J Sports Med. https://doi.org/10.1177/2325967118806295CrossRefPubMedPubMedCentral

21.

Uz A, Apaydin N, Bozkurt M, Elhan A (2007) The anatomic branch pattern of the axillary nerve. J Shoulder Elb Surg 16(2):240–244. https://doi.org/10.1016/j.jse.2006.05.003CrossRef

22.

Loukas M, Grabska J, Tubbs RS, Apaydin N, Jordan R (2009) Mapping the axillary nerve within the deltoid muscle. Surg Radiol Anat 31(1):43–47. https://doi.org/10.1007/s00276-008-0409-3CrossRefPubMed

23.

Zhao X, Hung LK, Zhang GM, Lao J (2001) Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle. Clin Orthop Relat Res 390:244–251. https://doi.org/10.1097/00003086-200109000-00028CrossRef

24.

Leechavengvongs S, Teerawutthichaikit T, Witoonchart K, Uerpairojkit C, Malungpaishrope K, Suppauksorn S, Chareonwat B (2015) Surgical anatomy of the axillary nerve branches to the deltoid muscle. Clin Anat 28(1):118–122. https://doi.org/10.1002/ca.22352CrossRefPubMed

25.

Bailie DS, Moseley B, Lowe WR (1999) Surgical anatomy of the posterior shoulder: effects of arm position and anterior–inferior capsular shift. J Shoulder Elb Surg 8(4):307–313. https://doi.org/10.1016/s1058-2746(99)90151-9CrossRef

26.

Burkhead WZ Jr, Scheinberg RR, Box G (1992) Surgical anatomy of the axillary nerve. J Shoulder Elb Surg 1(1):31–36. https://doi.org/10.1016/s1058-2746(09)80014-1CrossRef

27.

Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd (2000) Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res 373:259–264CrossRef

28.

Cetik O, Uslu M, Acar HI, Comert A, Tekdemir I, Cift H (2006) Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study. J Bone Jt Surg Am 88(11):2395–2399. https://doi.org/10.2106/jbjs.e.01375CrossRef

29.

Cheung S, Fitzpatrick M, Lee TQ (2009) Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach. J Shoulder Elb Surg 18(5):748–755. https://doi.org/10.1016/j.jse.2008.12.001CrossRef

30.

Rowles DJ, McGrory JE (2001) Percutaneous pinning of the proximal part of the humerus: an anatomic study. J Bone Jt Surg Am 83(11):1695–1699CrossRef

31.

Marsland D, Ahmed HA (2011) Arthroscopically assisted fixation of glenoid fractures: a cadaver study to show potential applications of percutaneous screw insertion and anatomic risks. J Shoulder Elb Surg 20(3):481–490. https://doi.org/10.1016/j.jse.2010.08.003CrossRef

32.

Eakin CL, Dvirnak P, Miller CM, Hawkins RJ (1998) The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures: an anatomic study. Am J Sports Med 26(4):505–509CrossRef

33.

Woolf SK, Guttmann D, Karch MM, Graham RD 2nd, Reid JB 3rd, Lubowitz JH (2007) The superior-medial shoulder arthroscopy portal is safe. Arthroscopy 23(3):247–250. https://doi.org/10.1016/j.arthro.2006.11.022CrossRefPubMed

34.

Becker C, Assouad J, Riquet M, Hidden G (2006) Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 243(3):313–315. https://doi.org/10.1097/01.sla.0000201258.10304.16CrossRefPubMedPubMedCentral

35.

Chen R, Mu L, Zhang H, Xin M, Luan J, Mu D, Liu C, Ji K, Hu J, Sun J, Xuan L, Rong Y, Zheng L, Tang P, Zhong X, Wu H, Zou T, Yang Z, Becker C (2014) Simultaneous breast reconstruction and treatment of breast cancer-related upper arm lymphedema with lymphatic lower abdominal flap. Ann Plast Surg 73(Suppl 1):S12–S17. https://doi.org/10.1097/sap.0000000000000322CrossRefPubMed

36.

Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA (2012) Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg 255(3):468–473. https://doi.org/10.1097/SLA.0b013e3182426757CrossRefPubMed

37.

Moatshe G, Marchetti DC, Chahla J, Ferrari MB, Sanchez G, Lebus GF, Brady AW, Frank RM, LaPrade RF, Provencher MT (2018) Qualitative and quantitative anatomy of the proximal humerus muscle attachments and the axillary nerve: a cadaveric study. Arthroscopy 34(3):795–803. https://doi.org/10.1016/j.arthro.2017.08.301CrossRefPubMed

38.

Cho B, Oka M, Matsumoto N, Ouchida R, Hong J, Hashizume M (2013) Warning navigation system using real-time safe region monitoring for otologic surgery. Int J Comput Assist Radiol Surg 8(3):395–405. https://doi.org/10.1007/s11548-012-0797-zCrossRefPubMed

Titel: Arthroscopic transosseous rotator cuff repair: how to avoid damaging the axillary nerve—a cadaveric study
verfasst von: José Antonio Blas-Dobón
Luis Aguilella
Daniel Montaner-Alonso
Maria Morales-Suárez-Varela
Publikationsdatum: 25.07.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 11/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03528-x

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Abstract

Introduction

Materials and methods

Results

Conclusions

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