Double-Row Rotator Cuff Repair Technique With Dermal Allograft Augmentation

Abstract

Rotator cuff tears are common and debilitating injuries in the orthopaedic patient population. Although arthroscopic repair of the rotator cuff generally leads to satisfactory outcomes, some tears would benefit from augmentation with allograft to supplement the native tissue. This biological augmentation has been shown to decrease retear rates and can be beneficial in certain cases based on the size of the tear, amount of retraction, age of the patient, and chronicity. In this technical note, we describe a simple and effective technique for arthroscopic rotator cuff repair with biological augmentation.

Fig 1

Patient draped and positioned in beach-chair position with McConnell arm holder (McConnell Orthopedic Manufacturing Company, Greenville, TX).

Fig 2

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing full thickness supraspinatus tear. (G, glenoid; H, humerus; SS, supraspinatus.)

Fig 3

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing medial-row bone tunnel on humerus (H) being prepared via bone punch. (SS, supraspinatus.)

Fig 4

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing medial-row suture anchor being deployed into prepared bone tunnel. (SL, SwiveLock; SS, supraspinatus.)

Fig 5

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing suture passed through torn rotator cuff using arthroscopic suture passer. (SS, supraspinatus.)

Fig 6

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing lateral-row suture anchor being deployed into prepared bone tunnel. (SL, SwiveLock.)

Fig 7

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the anterior portal with a 30 degree arthroscope showing completed repair using double-row technique.

Fig 8

(A) Graft loaded onto graft deployment device. (B) Graft prepared with high-strength retention sutures loaded on all 4 corners.

Fig 9

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing the dermal allograft being deployed.

Fig 10

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing tissue tag anchors (purple tag) being deployed through luggage-tag device. These are used to tack down the allograft to the repair. (DA, dermal allograft).

Fig 11

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing the suture anchors being deployed to secure graft over rotator cuff repair. (PL, PushLock.)

Fig 12

Patient positioned in the beach chair position. Arthroscopic image of the right shoulder through the posterior portal with a 30 degree arthroscope showing the (A) Final dermal allograft placement over lateral row of rotator cuff repair. (B) Final dermal allograft placement over medial row of double-row repair.