| The first really
successful operation for
the diagnosis of impingement or rotator cuff disease was originally done
by Dr. Neer in 1972. Amazingly, many if not most of the operations for this common
shoulder problem before 1972 were a failure. It was in 1934 that the
famous E A Codman repaired the first rotator cuff tear. It was
poorly received by the College of Surgeons. It didn't work well.
The reason that it didn't work was the same reason that Dr Neer's
operation did work. Over the top of the rotator cuff muscles
(see
the pictures and then push the back arrow and return here) is a roof
bone called the acromion. If this roof bone is curved or hooked,
then it may "impinge" on the cuff muscles. Dr Neer cut away the
front of the roof bone, called the operation an "acromioplasty" and then
repaired the cuff muscles. He then became the most famous shoulder
surgeon of the earth. Before Dr Neer decided to cut away the spur or
front of the impinging roof bone, there was really little hope for people
with rotator cuff disease or impingement. Since then, we have made a
lot of progress and can very often do what was once a big "open" operation
as an "all arthroscopic" procedure as an outpatient. Even the
rotator cuff can be fixed in many cases through the arthroscope.
Our results are fairly compared to the
literature and are really very good. Most studies give results of
good or excellent for the repair of the rotator cuff in over 90% of cases.
It is really the duty of orthopedic surgeons to try and study their
results. We have now done many thousands of cases and have studied
the results of the surgeries that have been performed by myself. In
two separate series of over 100 consecutive cases that were available for
follow-up to us at one or more years after surgery, the results were 94% good or
excellent. 57% felt as though they had a near normal shoulder and
37% reported a good result. The reasons most common for a good
result instead of an excellent result was lack of normal strength. There
was a correlation between tears that were present for a long time before
surgery and lack of normal strength. |
|
Failures of
rotator cuff surgery were mostly correlated with trauma after surgery,
failure to follow rehabilitation instructions, and previous failed
cervical spine surgery. Results for redo surgery approximate that
found by Dr. Bigliani in New York. About two thirds of patients that
had revision did well.
It is fair to say that results at our
office are quite good and are in line with results reported by
internationally respected authors.
All arthroscopic surgery has become more
popular in recent years. As the last decade has evolved, so has our
surgical technique. In the early years, we did mostly open surgery.
As the early 1990's arrived, so did our use of the arthroscope. In
the first 1000 cases or so, we did arthroscopy on all the patients having
an open operation. Eventually, after many meetings and much
practice, we began to perform more and more procedures all
arthroscopically. Now we are able to perform almost half of
all rotator cuff surgeries arthroscopically and almost every single
impingement operation all arthroscopically. I still believe that
really large and massive tears do better with an open operation and I will
continue to do the really massive tears open until I personally believe
that we can obtain results that match our original data. Currently,
the results for the all arthroscopic techniques are similar to the
original results that we noted as earlier mentioned which is great news
and suggests that all arthroscopic surgery for the rotator cuff, as well
as many other shoulder problems, is not only possible, but the expected
way of the future. |
