A Technique for Arthroscopic Double-Row Rotator Cuff Repair With Acellular Dermal Matrix Augmentation

Abstract

The outcomes of arthroscopic repair of large-to-massive rotator cuff tears remain suboptimal, with high retear rates reported. To overcome factors such as poor cuff quality and degenerate tendons with poor blood supply, augmentation with acellular dermal matrix allograft has emerged as a useful adjuvant procedure to promote healing. However, it remains a technically demanding procedure with a steep learning curve. Various described techniques require the use of additional suture anchors, tissue staples, or special instruments. This Technical Note describes a modified technique that streamline the steps and uses the standard 4 suture anchors for double-row cuff repair for the augmentation procedure.

Fig 1

Clinical lateral view of the right shoulder in the lateral decubitus position with arthroscopy portals established.

Fig 2

Arthroscopic view of right shoulder through a standard posterior viewing portal in lateral decubitus position: showing a large supraspinatus (SSP) tendon tear, which was debrided and mobilized. The footprint for cuff repair was prepared with a shaver.

Fig 3

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: insertion of anteromedial suture anchor at the anterior margin of the articular surface of supraspinatus tear. A representative schematic diagram is shown on the right. (AM, anteromedial.)

Fig 4

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: both limbs of the cuff repair suture (black stripes) are threaded through the anteromedial aspect of the supraspinatus tendon.

Fig 5

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: all 4 limbs of the patch augmentation sutures (blue stripes, blue solid) are passed through the tendon, medial to the cuff repair sutures (black stripes). A representative schematic diagram is shown on the right. (AM, anteromedial.)

Fig 6

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: all 4 limbs of the posteromedial patch augmentation sutures (blue stripes, blue solid) are passed through the tendon, medial to the cuff repair sutures (black stripes). A representative schematic diagram is shown on the right. (AM, anteromedial; PM, posteromedial.)

Fig 7

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: medial row cuff repair performed by securing the AM and PM cuff repair sutures (black stripes) with knots. A representative schematic diagram is shown on the right. (AM, anteromedial; PM, posteromedial.)

Fig 8

(A) Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position demonstrating the insertion of the posterolateral knotless anchor using the awl. (B) Arthroscopic view of right shoulder through a lateral portal in lateral decubitus position: double-row cuff repair completed with cross configuration using the cuff repair sutures (black stripes), with adjunct tapes (blue stripe tape) anchored into each PM and PL knotless suture anchor. A representative schematic diagram is shown on the right. (AL, anterolateral; PL, posterolateral; PM, posteromedial.)

Fig 9

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: AP patch size measurement between AM and PM patch augmentation sutures using a 5-mm arthroscopic probe as guide. The AP length was measured between the AM blue solid suture and PM blue stripes suture. A representative schematic diagram is shown on the right. (AM, anteromedial; AP, anterior-posterior; ML, medial-lateral; PM, posteromedial.)

Fig 10

(A) Preparation of patch ex vivo with the patient’s shoulder at the top of the clinical photo. AM and PM patch augmentation sutures are tied to each corner with 5 alternative half hitches. AL and PL adjunct tapes are passed through each corner. (B) Representative schematic diagram showing the sutures used at each corner. (C) Overall view of sutures and tapes. The remaining sutures/tapes not used to anchor the patch were retrieved through the anterior portal. (AM, anteromedial; AP, anterior-posterior; ML, medial-lateral; PM, posteromedial.)

Fig 11

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: Patch is shuttled into repair zone via lateral portal after sutures are pulled taut through the anterior portal. A representative schematic diagram is shown on the right.

Fig 12

Arthroscopic view of right shoulder through a standard posterior portal in lateral decubitus position: the medial patch fixation is completed after tying each pair of AM and PM patch augmentation sutures (1 blue stripe, 1 blue solid) with 5 alternating half hitches. A representative schematic diagram is shown on the right. (AM, anteromedial; PM, posteromedial.)

Fig 13

Arthroscopic view of right shoulder through a lateral portal in lateral decubitus position: the lateral patch fixation is completed after tying each pair of AL and PL adjunct tapes (blue stripes tape) with 5 alternating half hitches. A representative schematic diagram is shown on the right. (AL, anterolateral; PL, posterolateral.)

Fig 14

Arthroscopic view of right shoulder through a lateral portal in lateral decubitus position: Patch fixation complete. A representative schematic diagram is shown on the right.