Rotator Cuff Repair with Knotless All-Suture Medial Row Anchors and Biceps Autograft Augmentation

Abstract

Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors.

Fig 1

Arthroscopic view from the posterior viewing portal of a right shoulder identifying the intraarticular structures, including the humeral head (black arrow), glenoid, rotator interval, and subscapularis (labeled).

Fig 2

Arthroscopic view from the posterior portal of a right shoulder identifying the intraarticular structures, including the humeral head (black arrow), subscapularis (blue arrow), and the biceps tendon (labeled) and the superior labral and biceps pathology (yellow arrow).

Fig 3

Arthroscopic view from the posterior portal of a right shoulder subacromial space identifying the humeral head (blue arrow), rotator cuff (labeled), and a grasper through the lateral working portal assessing the rotator cuff tear (yellow arrow).

Fig 4

Arthroscopic view from the lateral working portal in the subacromial space demonstrating the completed double-row rotator cuff repair (blue arrows).

Fig 5

Arthroscopic view from the lateral working portal demonstrating the completed biceps autograft augmentation with medial PLGA soft tissue fixation (blue arrow) and lateral suture anchor fixation (yellow arrow).

Fig 6

The excised long head of biceps tendon is measured on the back table (blue arrow).

Fig 7

The biceps autograft is placed in the biceps autograft tissue compression plate on the back table (blue arrow).

Fig 8

The biceps autograft being “smashed” in the Modular Glenoid System Press (blue arrow).

Fig 9

Sutures are placed in the 4 corners of the “smashed” graft (black arrows) and loaded onto the CuffMend Augmentation System Graft Spreader device (blue arrow).

Fig 10

The biceps autograft (black arrow) loaded onto the delivery device (blue arrow).

Fig 11

The graft is delivered through the lateral portal (yellow arrow) using the Graft Delivery device (blue arrow).