Platelet rich plasma
2 main components
1. Platelets
- contain PDGF, TGF, VEGF
2. Growth factors
- ILGF
- FGF
Formed from the separation of whole blood into plasma and RBC
- separation usually achieved with centrifugation
Platelet concentration
Painful impingement of rotator cuff
- on anterior 1/3 of Acromion, CA ligament & ACJ
- causes tendinosis of the RC
1. Roof / CA Arch
- acromion
- CA ligament
- coracoid process
Improved cosmesis
Variable
- may be up to 50% retear over time
- many asymptomatic
1. Open antero-lateral approach
Large / Massive Cuff Tear
2. Deltopectoral approach
Large Subscapularis tear
3. Arthroscopic Assisted Mini-open
Indication
- Small / Moderate Cuff Tear < 3cm
- no retraction
Technique
- arthroscopic SAD
Pain & Stiffness
- often more pain than FT tears
Bursal side tears more painful than articular
Articular side more common
May see in young patient overhead throwing
Painful arc
Impingement signs
No weakness
- function good
Largest and most powerful rotator cuff
- arises coastal border of scapula
- superior 2/3 tendon inserts into LT
- inferior 1/3 inserts into proximal humerus
Action
- IR (with T major, P major, Lat Dorsi)
- part of force couplet depressing humeral head
Massive tear
1. > 5cm
- retracted to humerus / glenoid margin
2. At least 2 complete tendons
- lose SS / IS or SS / SC
Full thickness tear (FTT)
- variable amount retraction from insertion
Partial thickness tear (PTT)
- incomplete
- bursal or articular sided