Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair Augmentation With Interpositional Demineralized Bone Fiber Implant

Abstract

Failure of rotator cuff repairs contributes to decreased patient satisfaction and quality of life. Biologic enhancement of repairs represents a novel augmentation strategy attempting to reproduce native healing while concomitantly potentially decreasing the existing high failure rates associated with rotator cuff repairs. Scaffolds placed on top of the rotator cuff have been widely studied, yet no recreation of the native enthesis is achieved via this augmentation strategy. Several strategies involving placement of demineralized bone matrix scaffolds on an inlay configuration (between bone and tendon) have been reported demonstrating enhanced recreation of the native bone-tendon unit. This Technical Note describes the surgical technique of inlay demineralized bone fiber scaffold augmentation of rotator cuff repairs to enhance biological healing in aims of recreating the native enthesis.

Fig 1

Arthroscopic image of the 1.5- to 2-cm right shoulder rotator cuff tear as viewed from the lateral portal within the subacromial space approached via beach-chair positioning.

Fig 2

Right shoulder, beach-chair approach for arthroscopic portal placement is shown.

Fig 3

Arthroscopic image of double-loaded medial-row suture anchors over decorticated greater tuberosity on the right humeral head as viewed from the lateral portal via a beach-chair approach.

Fig 4

Arthroscopic image of the tissue penetrator piercing through the torn right shoulder tendon to shuttle medial-row anchor’s sutures through the healthy portion of the tendon for posterior lateral anchorage. Viewed from the lateral portal via a beach-chair approach.

Fig 5

Arthroscopic image of all 8 medial-row sutures retrieved through the right shoulder’s torn tendon with the tissue penetrator as viewed from a beach-chair approach lateral portal.

Fig 6

Arthroscopic image of the pilot hole and bone cut out, located on top of the right humerus, for preparation of inlay demineralized bone fiber implant placement. Viewed from the lateral portal via a beach-chair approach.

Fig 7

Arthroscopic image, as viewed from a beach-chair approach, lateral portal, showing the demineralized bone fiber implant being tapped in between the right shoulder’s humeral bone and tendon.

Fig 8

Arthroscopic image, viewed from the right shoulder’s lateral portal, displaying the implant in place at the center of the tuberosity allowing for optimal footprint coverage.

Fig 9

Right shoulder, beach-chair approach, lateral portal view of the inlay positioned implant after lateral pulling of the previously anchored medial-row sutures shuttled through the healthy portion of the torn tendon.

Fig 10

Beach-chair approach lateral portal arthroscopic image of the final right shoulder transosseous-equivalent, double-row rotator cuff repair with no visualization of the demineralized bone fiber implant as it lies between the tendon-bone unit (inlay configuration).