Arthroscopic Incomplete Rotator Cuff Repair With Patch Augmentation Using Acellular Dermal Matrix Allograft

Abstract

Arthroscopic rotator cuff repair has been shown promising clinical outcomes. However, large to massive rotator cuff tears are difficult to completely repair with appropriate tension because of their size or poor tissue quality. An incomplete repair using the "hybrid technique" is one of way to solve this problem by maximizing the contact area between the tendon and the footprint of greater tuberosity. Additionally, the acellular dermal matrix patch augmentation has emerged as an adjuvant technique to enhance the biomechanical properties to promote healing of the repaired construct. This Technical Note describes arthroscopic incomplete rotator cuff repair using the "hybrid technique" with acellular dermal matrix patch augmentation.

Fig 1

Outside lateral photo of the right shoulder in the lateral decubitus position with arthroscopy portals established. (a) P, posterior portal. (b) A, anterior portal. (c) AL, anterolateral portal. (d) PL, posterolateral portal. (e) PT, posterior traction portal. (f) AT, anterior traction portal. (g) N, Neviaser portal.

Fig 2

Incomplete rotator cuff repair using the “hybrid technique.” (a) Arthroscopic photo of the right shoulder in the lateral decubitus position viewed from the posterolateral portal of the incomplete repair construct. (b) Schematic image of incomplete rotator cuff repair in the right shoulder. Note that there is a coverage defect (orange) on the anterior portion of the greater tuberosity footprint and medialized anterior portion of the supraspinatus. Anterior portion of the supraspinatus tendon is repaired using a single-row repair with a modified Mason-Allen suture (purple) and Mason-Allen sutures.

Fig 3

Instruments for patch augmentation. (a) Suture retaining bar (Koros). (b) Bowel forceps. (c) Stand for a patch. (d) Ruler. (e) Cannula (Kii Optical; Applied Medical).

Fig 4

Preparation of patch augmentation. (a) Posterolateral traction suture. (b) Anterolateral traction suture. (c) Relay suture to shuttle the Mason-Allen suture of incomplete repair. Note that pen marking (blue color) indicates the intended passing point.

Fig 5

Aligned sutures before being passed through the patch. Outside photo of the right shoulder in the lateral decubitus position with (a) posteromedial traction suture from the incomplete repair, (b) medial traction suture from the Neviaser portal, (c) anteromedial traction suture from the anterior portal, and (d) Mason-Allen suture from the incomplete repair to be shuttled.

Fig 6

Suture passing into the patch. (a) Outside photo of the right shoulder in the lateral decubitus position. (b) Schematic image of the right shoulder for suture passing into the patch. Note that a knot pusher is engaged to the posteromedial traction sutures. The anteromedial and medial traction suture is passed through the patch using an anterograde suture passer (Scorpion; Arthrex) and secured using the “Megaknot” technique.

Fig 7

Insertion of the patch. Outside photo of the right shoulder in the lateral decubitus position showing the patch being pushed into the joint by the knot pusher and pulled by the anteromedial and medial traction suture at the same time.

Fig 8

Final construct of rotator cuff repair with patch augmentation. (a) An arthroscopic photo of the right shoulder in the lateral decubitus position viewed from the posterolateral portal showing a well-fixated patch covering from the defect of the incomplete repair to the musculotendinous junction of the repaired tendon. (b) Schematic image of the final construct.