METHOD OF ARTHROSCOPIC REPAIR OF PARTIAL-THICKNESS RUPTURES OF THE ROTATOR CUFF OF THE SHOULDER JOINT IN ATHLETES AND BALLET DANCERS Russian patent published in 2023 - IPC A61B17/00 A61B17/56 

FIELD: medicine, traumatology and orthopedics.

SUBSTANCE: invention can be used for arthroscopic repair of partial-thickness ruptures of the rotator cuff of the shoulder joint in athletes and ballet dancers. When the patient is in the "beach chair" position, the ports are marked for the introduction of arthroscopic instruments, then an incision of the skin and subcutaneous fat 4–5 cm long is performed in the projection of arthroscopic accesses. Access to the cavity of the shoulder joint is provided and using arthroscopic optics with a viewing angle of 30° a revision of the joint cavity is performed with visualization of the articular surface of the head of the humerus, the articular surface of the cavity of the scapula, the articular lip of the scapula, tendons of the long head m. biceps, tendons of the rotator cuff m. supraspinatus, tendons of the infraspinatus muscle m. infraspinatus, tendons of the subscapularis m. subscapularis, teres minor muscle m. teres minor, glenohumeral ligaments and capsule of the shoulder joint. Through the arthroscopic port at the 5 o’clock position, arthroscopic instruments are introduced into the cavity of the shoulder joint. Damage to the capsular-ligamentous apparatus of the cavity of the shoulder joint is revealed, as well as damage to the tendon of the rotator cuff. Arthroscopic optics are inserted into the subacromial space through the posterior arthroscopic access and port at the 5 o’clock position, and using a shaver and ablator inserted into the Wilmington port, bursectomy is performed with the release and visualization of the rotator cuff, the articular surface of the acromial process is treated with a shaver and ablator, subacromial decompression and acromionoplasty with removal osteophytes. Sparing acromionoplasty is performed through the anterior superolateral port with an increase in the subacromial space by 5 mm. The tendons of the rotator cuff are released with release from adhesions and scars, the edges of the damaged tendons of the rotator cuff of the supraspinatus and infraspinatus muscles are treated with a shaver. Decortication of the humerus is performed in the zone of attachment of the rotator cuff, tunnelization of the humerus, the zone of fixation of the rotator cuff is performed to integrate the rotator cuff to the humerus, and the injured upper limb of the patient is brought to the patient's body. The first channel is prepared, in which a biodegradable screw-type fixator Healix Advance DePuy 5.5 mm with ORTHOCORD or PERMACORD threads is installed. The tendons of the supraspinatus muscle are stitched and the threads are brought to the port of Wilmington; when stitching the tendon of the supraspinatus muscle, the arthroscopic optics are in the posterior arthroscopic access, while the arthroscopic instruments are in the anterior or anterolateral ports. The preparation of the second canal in the humerus is performed, in which a biodegradable screw-type fixator Healix Advance DePuy 5.5 mm with ORTHOCORD or PERMACORD threads is installed and the tendon of the infraspinatus muscle is sutured with ORTHOCORD or PERMACORD threads with sequential application of "sliding" sutures, while the arthroscopic optics is located in the anterior arthroscopic port, respectively, the arthroscopic instrumentation is located in the posterolateral port. The knots are tightened and the threads are cut outside the knot. An arthroscopic rotation test is performed. A Dezo orthosis is performed with an abduction angle in the shoulder joint from 45° up to 60°. In some cases, the posterior arthroscopic port is located 1–2 cm below and 1–2 cm medial to the posterolateral angle of the acromion, the anterior port is located above the lateral half of the subscapularis tendon, medial to the biceps retinaculum, the anterior superolateral port is located 5–10 mm lateral to the anterolateral angle acromial process. The port at the 5 o’clock position for arthroscopy of the shoulder joint is localized 1–1.5 cm below the anterior port through the tendons of the subscapularis muscle, the Wilmington port is placed 1 cm anteriorly and 1 cm lateral to the posterolateral angle of the acromial process, and that the posterolateral port is located 4–5 cm distal and 4–6 cm lateral to the posterolateral angle of the acromion.

EFFECT: method provides reduction of surgical aggression and tissue injury and restoration of the shape and function of the structures of the shoulder joint due to the sequence of the method techniques.

6 cl, 3 ex