Arthroscopic Rotator Cuff Repair With Allograft Augmentation: Making It Simple

Abstract

Rotator cuff tears are increasing in frequency in the aging population and are a common issue seen by orthopaedic surgeons. In patients with large, multi-tendon rotator cuff tears or retears, treatment can be challenging. Failure rates of up to 90% have been reported for rotator cuff repair (RCR) of large, multi-tendon tears. Biological augmentation has been an area of interest because of the distinctly different biology of the repaired tendon compared with the native tendon. These biological differences affect the ultimate tensile properties of the repair and may contribute to gap formation and the high failure rate of repairs. RCR with allograft augmentation is a technique that shows potential benefit to healing and preventing retears. Arthroscopic augmentation of RCRs can be challenging. The technique described in this Technical Note illustrates a simple and easily reproducible method for augmenting RCRs with human acellular dermal allograft.

Fig 1

Arthroscopic image of left shoulder in lateral decubitus position from posterior portal. A sharp trocar is placed percutaneously and in a transtendinous manner in the anteromedial position for desired graft placement.

Fig 2

Arthroscopic view of left shoulder in lateral decubitus position from posterior portal. Both the anteromedial and posteromedial anchors are in place through the rotator cuff tendon and are ready to shuttle the graft into the subacromial space.

Fig 3

Acellular human dermal allograft with shiny, pigmented, dermal side up, prepared to be marked and cut to fit arthroscopic measurements.

Fig 4

Use of an arthroscopic suture passer to pass the posterior suture limb through the posteromedial corner of the marked allograft.

Fig 5

Tensioning of graft-shuttling construct. An arthroscopic grasper is holding the lateral edge of the graft while tension on the anterior and posterior suture limbs advances the graft toward the lateral cannula.

Fig 6

Shuttling of the graft through the lateral portal cannula while equal tension on the anterior and posterior suture limbs is combined with gentle pressure through the arthroscopic grasper on the graft.

Fig 7

Arthroscopic image of left shoulder in lateral decubitus position from posterior portal. By use of an arthroscopic suture passer, the anterolateral suture is passed through the corresponding anterolateral corner of the graft.

Fig 8

Arthroscopic image of left shoulder in lateral decubitus position from lateral portal. The allograft is tensioned appropriately over the rotator cuff repair site with the arrow pointed medially to the rotator cuff muscle.