Management Strategies for Rotator Cuff Defects After Calcific Tendinitis Debridement

Fig 1. Anteroposterior radiograph, of patient's right shoulder, with calcific deposit (circle) marked within the supraspinatus tendon near its insertion on the greater tuberosity.

Fig 2. A calcific deposit (circle) on the bursal aspect of the supraspinatus in a right shoulder, as viewed from the lateral portal, is debrided using an arthroscopic shaver, resulting in a relatively small partial-thickness tendon defect. Of note is the extent of inflammatory tissue reaction present adjacent to the calcific deposit. The patient is in the beach-chair position.

Fig 3. The use of a spinal needle via the lateral portal is shown probing tendinous tissue (arrow) in an effort to elicit calcific deposit “snow” that helps to localize the deposit within the rotator cuff tissue in a left shoulder. The patient is in the beach-chair position.

Fig 4. A blunt arthroscopic probe, introduced through the anterior portal, is used to apply external compression to a fluid-filled calcific deposit (arrow) in the rotator cuff tissue in a left shoulder, viewed from the lateral portal, causing increased extravasation. The patient is in the beach-chair position.

Fig 5. A very large, transtendinous calcific deposit (arrow) in a left shoulder, viewed from the posterior portal, is seen and approached from the articular aspect of the tendon. The articular aspect of the humeral head is marked by a star. The assistant or limb holder should hold the arm in slight abduction and external rotation to provide the best visualization of the articular aspect of the supraspinatus, as seen in this image. The shaver is introduced through the anterior portal in this case. The patient is in the beach-chair position.

Fig 6. A spinal needle–guided marking suture, introduced through the lateral portal and viewed from the posterior portal, is used to aid in identifying the adjacent bursal-sided rotator cuff tissue and calcific deposit within the subacromial space in a left shoulder. The patient is in the beach-chair position.

Fig 7. A partial-thickness defect in the rotator cuff (circle) in a right shoulder is visualized via the lateral portal after calcific deposit debridement using an arthroscopic soft-tissue shaver via the posterior portal. The patient is in the beach-chair position.

Fig 8. In a left shoulder, excision of a large calcific deposit results in a full-thickness rotator cuff defect, visualized via the lateral portal, that is repaired using side-to-side convergence sutures. The patient is in the beach-chair position.

Fig 9. A large, full-thickness defect, viewed from the lateral portal, is shown after excision of the calcific deposits in a left shoulder. A large bone void is visible in the greater tuberosity. The patient is in the beach-chair position.

Fig 10. Adequate mobility of the tendinous tissue allows for the reapproximation of a full-thickness defect in a left shoulder, with little tension, using 2 side-to-side convergence sutures. This technique is used if there is a large cyst in the region of the greater tuberosity or if very poor bone quality precludes suture anchor placement. The repair is visualized from the lateral portal in this case, and the patient is in the beach-chair position.

Fig 11. A large, full-thickness supraspinatus defect is shown, as viewed from the lateral portal, subsequent to complete calcific deposit excision in a left shoulder. The patient is in the beach-chair position.

Fig 12. An anchor-supplemented repair of a full-thickness supraspinatus defect is seen, viewed through the lateral portal, incorporating the margins of the rotator cuff defect in a left shoulder. The patient is in the beach-chair position.