A case report of re-implanting a neglected avulsion of supraspinatus tendon by arthroscopic and open surgeries

INTRODUCTION: Rotator cuff constitutes a mechanical arm and an important stabilizing factor for the shoulder joint, and the supraspinatus muscle is the initiator of the movement of arm in the abduction direction. Rotator cuff injuries constitute an important part of the shoulder pain, and many cases are managed conservatively, nevertheless, open or arthroscopic surgery remains a must in many cases. CASE REPORT: We present the case of a patient in the sixth decade of life who complained of absence of abduction movement in his right shoulder three months ago after he lifted a heavy object. The clinical examination showed a positive sign of drop arm and other clinical signs indicating absence of supraspinatus muscle function. The MRI also showed a full-thickness tear of the supraspinatus tendon and its retraction away from its original inserting point on the greater tuberosity of the humerus. The case was managed by re-implanting the ruptured tendon by combining arthroscopic and open surgeries and using two anchors with slipable sutures, adopting the principles of duplicated knots and multiple transverse entry through the tendon to get a firm fulcrum. The results were clearly good after rehabilitation with a wide and powerful ROM (Range of Motion). DISCUSSION: Many cases of RCT (Rotator Cuff Tears) are concretively managed by using corticosteroids injections into the subacromial space with results of significant improvement in symptoms, and arthroscopic surgery is of increasing importance in preventing the development of small partial or full thickness tears and in reconnecting complete or avulsion tears early. The current case is characterized by a clear contraction of the completely avulsed tendon with severe adhesions due to neglection of the case for several months, which made the possibilities of arthroscopic surgeries limited only by acromioplasty, loosening some adhesions and preparation of the footprint, as well as making open surgery mandatory to give a wide area for doubling the suturing layers and then re-implanting the avulsed tendon into its original anchor. CONCLUSION: Neglect and delay in managing full-thickness tears in the supraspinatus tendon are the important reasons for the occurrence of adhesions and fibrosis, which in turn hinder the process of re-implanting the ruptured tendon at its original anchor through arthroscopic surgery, so that open surgery becomes the mandatory solution. It is necessary to use anchors with slipable threads and to focus on doubling the suturing layers with repeatedly entering through the muscle tendon to reduce it to the footprint firmly and strongly by tightening the slipable threads through the anchors.