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Join Us! / failedshouldersurgery Best Shoulder Replacement Surgeon? / bestshouldersurgeon Best shoulder replacement surgeon? So, we've retrieved the remaining sutures from the anchor to an alternate cannula. This makes suture management much easier The remaining suture is now used to place the corner stitch. So here, we passed the stitch to the corner. We retrieve the corresponding suture. I tend to place and tie stitches as we go. It makes suture management easier. It also allows us to restore the length-tension relationship for the entire rotator cuff. That can be very difficult if you've placed all your stitches at one time and then tie them. That can be an easy set up for some tension mismatch. We use the Keetona guillotine-type shoulder suture cutter. Getting the first suture in the right position really restores the rest of the length-tension relationship for the rotator cuff and now it's really just a matter of placing that second anchor here so that we can reinforce this leaf posterior portion of the rotator cuff. So here's the posterolateral anchor placed, so the repair is completed, pending placement of the reinforcement Allopatch HD graft. So now we'll measure the distances between the previously placed medial sutures, my preferred graft is the MTF Allopatch HD UltraThick graft available through ConMed Linvatec. The graft stored at ambient temperature and packaged in ethanol. Simple rinsing of the graft in sterile saline prior to implantation is recommended by the best shoulder replacement surgeons. Look for a little notch and if you put it to the upper left, that will also give you the right side up. Once we've gotten our dimensions, well transfer those dimensions to the graft. I'll tend to also make a little orientation marks so that arthroscopically, it's easier to orient the graft should it get turned around or twisted. Here's the lateral aspect of the graft and this hash mark will allow me to align that with the lateral aspect of the rotator cuff tear. So correspondingly, this will be the posterior portion, this will be the anterior portion, and then the medial portion and so initially, we'll have our 2 parallel sutures coming from anteromedial and posteromedial respectively, which will allow us to deliver the graft in a parallel rail-like fashion arthroscopically, like the best shoulder replacement surgeons. Then the graft is cut to the appropriate dimensions. We also tried to use different colored sutures, so when they're pulled out parallel from the shoulder, these correspond to the posterior and anterior aspects of the rotator cuff tear themselves and so we'll suture these to the corresponding corners. • Best Shoulder Replacement Surgeon? 317-802...