Case Study: Arthroscopic Surgery: Shoulder Rotator Cuff
Repair, Medial Meniscectomy with Microfracture
Chondroplasty of the Knee and Shoulder Extensive
Debridement in a 47 year-old female

Reattaching the rotator cuff tendon to the head of the humerus (upper arm bone) is the most common surgical procedure used to treat a torn rotator cuff. In order to create a stable remnant meniscus, unstable flaps of a torn meniscus must be removed.

In order to provide the joint’s gliding surface a smoother surface, two of these procedures are employed to assist smooth out damaged, irregularly shaped cartilage: chondroplasty and microfracture.

Debridement is an arthroscopic operation used to remove debris, damaged cartilage, or tissue from inside a joint, successfully healing the damaged joint. The debridement method is primarily utilized to address shoulder issues in addition to being used to treat numerous joints across the body.

The patient is a 47 year-old female, presented with left shoulder pain. She encountered an accident but had no pain before that. She also complains of right knee pain which is new since the accident. She did have back pain before the accident which was relieved but got aggravated with the accident. We agreed to take an MRI.

MRIs were reviewed and discussed by the doctor, which showed high-grade partial rotator cuff tears of the left shoulder. We discussed treatment options and opted for surgical management.

We discussed the risks and benefits including infection, bleeding, injury to adjacent nerves and vessels, need for repeat surgery, failure, need for shoulder rehabilitation among others. We also discussed systemic complications including blood clot, cardiac, pulmonary, or neurological complications including death. The patient understood and signed an informed consent.

The patient was taken to the operating room where she was placed on a well-padded operating table. The patient was sedated and a supraclavicular block was given. General anesthesia was induced. The patient was positioned in the right lateral position with the left shoulder up.

The patient was then positioned with the usual bean bag. All the bony prominences were well padded. The neck, shoulder, and upper extremities were prepped and draped aseptically in the usual fashion. Time-out was called. Preoperative antibiotic was given.

Posterior entry portal was made for the laparoscope in the soft spot. The arthroscope was inserted into the glenohumeral joint. Anterosuperior portal was made with the use of a spinal needle. An examination of the glenohumeral joint showed fraying of the subscapularis as well as glenoid labrum.

The biceps were intact, there was no tear and no chondral damage to the glenohumeral joint. Arthroscopic shaver was used to debride the glenoid labrum as well as the subscapularis tendon. The arthroscope was entered into the subscapularis space from the posterior portal and the shaver was entered from the anterior portal.

Subacromial bursectomy was performed. Examination showed fraying of the acromion as well as type 2 acromion. Also showed high-grade partial thickness tear of the supraspinatus tendon. Debridement of the tendon was done to mark the footprint. The footprint was prepped with the use of bur.

Regenesorb Healicoil two-tailed 4.75 anchor was used from Smith and Nephew and inserted after tapping into the humeral head. The tail of the suture was passed x2 through the tendon and tied on to each other. This achieved a good reduction and closure of the rotator cuff tear.

The other jig was discarded. Coblation wand followed by a burr was used to perform acromioplasty. Distal clavicular excision was performed through the posterior portal and followed by the anterior portal. About 1 cm of distal clavicle was excised. Final pictures were taken and saved.

The left shoulder was thoroughly irrigated and drained. Closure was done with the use of # 3-0 nylon. Dressing was done with the use of Xeroform, 4 x 8, ABD, tape. Shoulder immobilizer was applied. The patient was extubated and moved to recovery in a stable condition.

Arthroscopic images taken during the surgery

Arthroscopic images taken during the surgery

After one week the patient was seen in the office, she is here for her postoperative examination, no x-rays were needed. She denies fever, chills but her right shoulder is also hurting. She also developed rash over the neck, arm and chest wall since the last few days which has not been improving.

She took Benadryl also. Before discussing treatment, options and proceed with formal physical therapy as well as a home exercise program for rehabilitation of the shoulder.

We have decided to do the right RCT repair and that is needs to be planned for later, we also discussed the right knee arthroscopic chondroplasty, measurement of cartilage lesion and possible biopsy to be planned on next visit.

May need MACI in future, and the patient might see PCP for rash and restart Clindamycin for 5 days for discharge from surgical wounds. We went over the arthroscopic pictures and removed the stitches during the visits. We will continue with ice and elevation of the shoulder to decrease swelling and pain.

We will wean them off any narcotic medications and progress to anti-inflammatories and Tylenol as long as there are no contraindications to these medications. We also discussed the risk and benefits and common side effects of taking these medications. The doctor sees the patient back in three weeks’ time to evaluate her progress and discuss the next procedures.

After one month the patient visits the office to do an MRI for another possible surgery, the MRI reviewed and discussed by the doctor, it showed that the patient had a subchondral fracture and cyst in the medial tibial plateau. We discussed treatment options and opted for surgical management.

We discussed risks and benefits including infection, bleeding, injury to adjacent nerves and vessels, need rehabilitation, need to be using crutches and non-weight bearing, and systemic complications including blood clot, cardiac, pulmonary, neurological complications including death. The patient understood and signed an informed consent.

MRI-3T Right shoulder non-contrast

MRI-3T Right shoulder non-contrast

MRI-3T Cervical Spine non-contrast

MRI-3T Cervical Spine non-contrast

The patient was taken to the operating room for a second time, where she was placed on a well-padded operating table. General anesthesia was induced. The left lower extremity was prepped and draped aseptically in the usual fashion. The left lower extremity was put on.

Tunica was applied on the right side and the leg was clamped. Draping was performed in aseptic fashion. Time-out was called. Tunica was elevated. Lateral entry portal was made with a parapatellar incision. Arthroscope was inserted and the median entry portal was made with the use of a spinal needle.

Examination of the medial femoral condyle showed lateral free-margin degenerative tear of the medial meniscus along with grade 4 osteoarthritic changes around medial tibial plateau extending from the anterior to the posterior surface along the region.

Examination of the medial intercondylar notch and lateral compartment showed no abnormality. Examination of the patellofemoral compartment showed 2 to grade 3 osteoarthritic changes of the lateral facet of the patella, which was debrided with the use of shaver. A biter was used for the meniscectomy on the medial meniscus. Microfracture chondroplasty was performed in multiple spots over the medial femoral condyle.

Final picture was taken and saved. Arthroscope was removed and plan for medial tibial plateau fixation was done. Incision was marked under fluoroscopy correlating with the MRI pictures.

Subchondroplasty needles x3 were inserted in the region and checked in the rotational fluoroscopy and drawn to be in acceptable position. A 3 cc of calcium triphosphate cement, which was premixed, was injected and trocars were inserted over the noodle to push that cement into the bone.

Pictures were taken to check and confirm the position of the cement. The cement was allowed to cure for about eight minutes after which the cannulas were removed and the area was cleaned. Picture was taken and saved again.

The incision was thoroughly irrigated and drained. Closure was done with the use of #2-0 subcu and # 3-0 nylon for the skin. A 20 cc of 0.5% Marcaine was injected into the knee. Dressing was done with the use of xeroform, 4 x 8, ABU, webril, and Ace wrap. The patient was extubated and moved to recovery in a stable condition.

The patient has been seen in the office multiple times in the past and has undergone arthroscopic surgery. She has been complaining of right shoulder pain for some time. We have tried cortisone injections in the AC joint as well as subacromial space, which have helped, but temporarily.

The patient has tried physical therapy also, it has helped temporarily. We discussed treatment options. We did an MRI, which showed a partial thickness rotator cuff tear along with acromial spurring, no meningeal arthritis.

The patient was seen by me multiple times in our office with complaints of injury, pain in both shoulders and both knees after a traffic accident. The patient had arthroscopic surgery on her knee and shoulder in the past.

At this time, she was complaining of right shoulder pain since her accident which has not improved despite cortisone injections and physical therapy. We did an MRI, which showed a partial rotator cuff tear. There was acromial spurring and AC arthritis.

Also, we discussed treatment options and opted for surgical management. We discussed risks and benefits and complications including infection, bleeding, injury to adjacent nerves and vessels, need for repeat surgery, need for rehabilitation, systemic complications including blood clot, cardiac, pulmonary, neurological complications among others. The patient understood and signed an informed consent.

The patient was taken to the operating room for the third time, where she was placed on a well-padded operating table. General anesthesia was induced. A supraclavicular nerve block was given in the holding area already. Preoperative antibiotic was given.

The patient was placed in a left lateral position with the right shoulder up. The right shoulder was prepped and draped aseptically in the usual fashion. Time-out was called. Bony prominences were marked over the skin and incision was given along the soft spot posteriorly to enter the glenohumeral joint.

A spinal needle was used to make an anterosuperior portal. Under arthroscopic guidance, an incision was given. The cannula was inserted along an anterosuperior portal.

A probe was inserted and examination of the glenohumeral joint was done, which showed extensive tearing of the labrum on the superior and the anterior part. There was tearing of the subscapularis tendon as well as intra articular tearing of the supraspinatus and the infraspinatus tendons.

A shaver was inserted from the anterosuperior portal and the debridement of the glenoid labrum, subscapularis, supraspinatus, and infraspinatus was performed. Pictures were taken and saved. There was no lesion on the glenoid cartilage.

The scope was inserted into the subacromial space and shaver was introduced and a subacromial bursectomy was done. There was acromial spurring. A Coblation wand was used followed by a burr to do an acromioplasty and remove the acromial spur along with release of the CA, coracoacromial ligament.

The 1-cm of distal clavicle was also excised with a burr. There was no rotator cuff tear seen on the bursal site. The shoulder was thoroughly irrigated and drained.

Final pictures were taken and saved. Closure was done with # 3-0 nylon. Dressing was done with Adaptic, 4×4, ABD, tape. The patient was put in a shoulder immobilizer and extubated and moved to recovery in a stable condition.

With regular visits and continued physical therapy and home remedies which are such a big help to the patient, she became well after all the surgery she went through.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

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Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
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22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
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00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
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I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
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21:28 23 May 22
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23:31 19 May 22
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19:54 16 May 22
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
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23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
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19:37 09 May 22
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19:54 05 May 22
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The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
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03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
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22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
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16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
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02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
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14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.