Dermal Allograft Augmentation of Rotator Cuff Repair via the Arthroscopic Shoulder Kite Technique

Abstract

Rotator cuff tears are a common cause of shoulder pain and dysfunction. Recent and historical reports suggest that a sizable percentage of patients may experience a retear of the rotator cuff despite surgical intervention. Multiple biological and mechanical factors can influence outcomes after rotator cuff surgery, including patient age, rotator cuff tear size, chronicity, and rotator cuff tissue quality. Given this, there remains significant interest in modalities that can minimize surgical failure and improve patient outcomes after this procedure. Allograft augmentation is one option for rotator cuff augmentation in patients with large complex tears or impaired tissue quality. This technical note describes our surgical technique for arthroscopic dermal allograft augmentation of a massive rotator cuff repair with the shoulder kite technique.

Fig 1

(A) Arthroscopic view of right shoulder from lateral portal via 30° arthroscope with patient in beach-chair position. Regarding orientation, left is posterior, top is medial, right is anterior, and bottom is lateral. A pair of untied middle suture limbs from the posterior suture anchor are visualized posterior to double-row fixation of the native rotator cuff. (RCT, rotator cuff tear.) (B) Sketched view of 12 suture limbs prior to rotator cuff repair. Both suture anchors have a pair of middle suture limbs passed through the musculotendinous junction for graft delivery and fixation. © Copyright 2024 by The Curators of the University of Missouri, a public corporation.

Fig 2

Initial pre-sized dermal allograft patch with 2 cinch sutures applied to its lateral edge on back table. The medial edge of the graft is marked with a marking pen.

Fig 3

Surgical field showing final dermal allograft patch with 2 medial mulberry knots from untied medial suture limbs of suture anchors, 2 lateral cinch sutures, and additional arrow marking with marking pen to indicate medial edge of graft.

Fig 4

(A) Arthroscopic view of right shoulder from lateral portal via 30° arthroscope with patient in beach-chair position. Regarding orientation, left is posterior, top is medial, right is anterior, and bottom is lateral. The posterior pair of suture limbs with 1 suture limb is already tied to the medial edge of the graft with a mulberry knot. The reciprocal untied suture limb is being pulled to shuttle the graft onto the rotator cuff repair via the anterolateral portal. (B) Sketched view of suture limbs prior to graft shuttling. One suture limb from each pair of untied sutures is tied to the medial edge of the graft with mulberry knots. © Copyright 2024 by The Curators of the University of Missouri, a public corporation.

Fig 5

Arthroscopic view of right shoulder from lateral portal via 30° arthroscope with patient in beach-chair position. Regarding orientation, left is posterior, top is medial, right is anterior, and bottom is lateral. A switching stick is used to provide counter tension and prevent the graft from lifting while the reciprocal untied suture limb is pulled to allow tightening of the mulberry knot suture limb to a firm endpoint.

Fig 6

(A) Arthroscopic view of right shoulder from lateral portal via 30° arthroscope with patient in beach-chair position. Regarding orientation, left is posterior, top is medial, right is anterior, and bottom is lateral. A 3.9-mm SwiveLock anchor is tapped and seated into the lateral humeral head to allow for 1 of 4 fixation points of the graft. (B) Sketched view of final 4-point fixation of dermal allograft augmentation. © Copyright 2024 by The Curators of the University of Missouri, a public corporation.