Biologic Footprint Reconstruction: Rotator Cuff Repair Using Biologic Tuberoplasty

Abstract

Irreparable rotator cuff tears present significant challenges owing to tear size, tendon retraction, and poor tissue quality. This article describes a surgical approach integrating biologic tuberoplasty with rotator cuff repair, using an acellular human dermal allograft to re-establish the rotator cuff footprint and prevent bone-on-bone contact between the humeral head and acromion. Footprint reconstruction is defined as allograft coverage of the tuberosity combined with partial cuff repair that includes some contact of the native cuff over the allograft. Changing the nomenclature to "biologic footprint reconstruction" more accurately describes the procedure when combined with partial cuff repair in continuity with the allograft and avoids confusion with isolated biologic tuberoplasty. The graft alleviates pain and creates a biologic healing environment. This approach is designed to reduce surgical complexity and improve efficiency, ensuring reproducibility while restoring shoulder biomechanics and function.

Fig 1

Arthroscopic image of a right shoulder with the patient in the beach-chair position, viewed from the lateral portal. The decorticated greater tuberosity footprint is shown with placement of 3 medial-row anchors: posterior (black arrow), middle (purple arrow), and anterior (green arrow). This configuration establishes the foundation for graft fixation in biologic tuberoplasty and shows appropriate medial-row spacing to optimize graft compression and coverage.

Fig 2

Arthroscopic view of a right shoulder with the patient in the beach-chair position. (A) Anterior-posterior footprint length is measured (from blue arrow to black arrow) using a superior capsular reconstruction (SCR) guide. (B) Medial-lateral footprint width is similarly measured (from blue arrow to black arrow). These dimensions are critical for tailoring graft size to achieve adequate coverage of the decorticated tuberosity during biologic tuberoplasty.

Fig 3

Intraoperative view of the back table. (A) The human dermal allograft (black arrow) is measured based on the anterior-posterior and medial-lateral dimensions of the tuberosity footprint. (B) The graft is trimmed, and sutures are placed in the 4 corners as follows: anterolateral, blue-and-white FiberLink suture tape in a luggage-tag configuration; posterolateral, black-and-white TigerLink suture tape in a luggage-tag configuration; anteromedial, blue-and-white FiberLink suture tape in a simple stitch configuration; and posteromedial, black-and-white TigerLink suture tape in a simple stitch configuration.

Fig 4

Arthroscopic view of a right shoulder with the patient in the beach-chair position. (A) The suture anchor configuration is prepared on the greater tuberosity for graft fixation. (B) The dermal allograft is shuttled into the joint through a lateral PassPort cannula and positioned over the decorticated tuberosity. This technique facilitates controlled graft insertion and accurate placement for biologic tuberoplasty. Black arrow indicates the shuttle suture used for graft passage.

Fig 5

Arthroscopic view of a right shoulder with the patient in the beach-chair position showing the final construct. The repaired rotator cuff (blue arrow) is augmented with a dermal allograft placed over the greater tuberosity (black arrow) as part of the biologic tuberoplasty. This configuration restores the superior shoulder contour and provides a biologic scaffold to protect and reinforce the repair.