Arthroscopic Assisted Mini Open Rotator Cuff Repair using Acromial Split: An Ethical Hack to Flatten the Shoulder Surgery Learning Curve

Author(s): Zafar Israil, Pradyumna Sharma, Rohit Vikas, Narender Reddy

Mini Open Rotator cuff repair is a dynamic term that encompasses Diagnostic arthroscopy of shoulder, sub acromial decompression, identification and tagging of torn rotator cuff tendons followed by flexible conversion to open repair by extending the lateral portal. Acromial split of anterior edge of acromion gives full exposure of entire footprint of rotator cuff tendons aided by rotation of the arm in lateral decubitus position.

Frequently, rotator cuff tendon tears have complex patterns and size which makes all arthroscopic procedure complex and tedious. Adding acromial split to 5 cms of anterolateral deltoid raphe split and 1cm lateral end clavicle excision gives about 10 cms exposure to do complex repairs. The sliver of acromion is fixed with #2 ethibond sutures at the time of closure and heals onto the acromion surface. This mini open approach enables to flatten the shoulder surgery learning curve because of combining the benefits of arthroscopic visualization to tag the tear and completing the repair with open techniques. Complex repairs like biceps SCR, Fascia lata SCR, subscapularis and infraspinatus double row repair and lower trapezius tendon transfer have been performed by this study group with excellent results.

42 patients, 26 males and 16 females with MRI confirmed various rotator cuff tear patterns were operated with this technique in Military Hospitals Jalandhar and Bareilly in India from 2020 to 2024. The average age of patients was 52.5 years and follow up was variable from 6-24 months.

38% of patients had complete supraspinatus tear, 23.8% has partial suprasinatus tear, 16.6 % had supraspinatus with infraspinatus tear, 9.5% has supra+infra+partial subscapularis tears and 12% had supraspinatus with partial subscapularis tears.

40 % of patients with 6 months follow up had average Constant score improved from 26 to 71.5 after the surgery. Another set of 40 % of patients with 12 months follow up had average Constant score improved from 22 to 86.4 after the surgery. 15% of patients with upto 2 years follow up had their average Constant scores improved from 18.7 to 89.7. The results are consistent with similar mini open rotator cuff surgeries in literature.

This study proves the hypothesis that Arthroscopic assisted Mini open Rotator cuff surgeries performed with Acromial split gives enough exposure to do a myriad pattern of Repairs with excellent outcomes and is an ethical hack to do complex repairs.