Rotator cuff repair augmented with endogenous fibrin clot

Abstract

Despite recent technical advances, rotator cuff repair continues to have a high retear rate. Recent research focused on biologic augmentation of rotator cuff repair with platelet-rich plasma has shown mixed results, and use of an endogenous fibrin clot from either peripheral blood or bone marrow may have advantages over the use of platelet-rich plasma. This technique describes a method to make an endogenous fibrin clot and arthroscopically apply the fibrin clot to the superior surface of the rotator cuff repair site.

Figure 1

The endogenous fibrin clot ring forms on the sintered glass cylinder after 30 mL of the patient's blood is swirled in the cup for 10 minutes. Forming the fibrin clot in this fashion aligns fibrin and imparts a structural integrity readily allowing for suture fixation.

Figure 2

With the patient in the lateral position, the No. 0 Vicryl docking sutures are brought out through the flexible lateral cannula in this right shoulder. The endogenous fibrin clot is tied to the No. 0 Vicryl docking sutures with multiple square knots.

Figure 3

With the endogenous fibrin clot secured to the 2 No. 0 Vicryl docking sutures with multiple square knots, the endogenous fibrin clot is first pulled into a metal cannula with an arthroscopic grasper and then passed through the dam of the flexible lateral cannula and into the subacromial space. In this image of a right shoulder with the patient in the lateral position and viewed from the posterior portal, the endogenous clot secured to the No. 0 Vicryl sutures is emerging from the metal cannula that is used to pass the clot through the dam of the flexible lateral cannula.

Figure 4

Once passed into the subacromial space, the endogenous fibrin clot is “docked” to the superior aspect of the rotator cuff repair at the tendon-bone interface by simultaneously pulling on the ends of the No. 0 Vicryl sutures exiting the anterior and posterior portals, respectively. With the endogenous fibrin clot docked, the ends of the sutures are brought out through the lateral cannula and tied arthroscopically medial to the clot-repair interface. This image of a right shoulder with the patient in the lateral position is viewed from the lateral portal and shows the endogenous fibrin clot docked on the superior aspect of the tendon-bone interface and the sutures tied medially.