BACKGROUND

Nearly half a million rotator cuff repairs are performed annually in the United States. Rotator cuff healing occurs at the interface between the tendon and greater tuberosity, known as the enthesis. Given that a significant number of rotator cuff tears do not heal following surgical repair, multiple adjunctive strategies have been devised to improve the structural integrity of the repaired construct. Recently, a biphasic, demineralized allograft bone implant has been developed to improve enthesis healing.

INDICATIONS

Relative indications for use of tissue augmentation include greater tuberosity osteopenia, revision rotator cuff surgery, attenuated rotator cuff tissue quality, and massive rotator cuff tears. Relative contraindications include a history of infection and recent immunosuppression.

TECHNIQUE DESCRIPTION

Following preparation of the footprint with an arthroscopic burr, two triple-loaded PEEK suture anchors were placed along the medial aspect of the greater tuberosity. Sutures were then passed through the rotator cuff tendon in a horizontal mattress configuration, and each pair of suture limbs were tied along the medial row. To aid in arthroscopic passage, the biphasic graft is folded longitudinally and clamped with a curved hemostat. The graft is loaded into an arthroscopic cannula and both are delivered simultaneously through a lateral arthroscopic portal. Two 18-gauge spinal needles are placed percutaneously to fix the allograft in the desired position. Subsequently, double-row transosseous-equivalent rotator cuff repair with standard techniques is done, which provides sufficient stability to the graft.

DISCUSSION

In a series of 192 patients who underwent arthroscopic rotator cuff repair augmented with a similar bioinductive collagen implant, patients demonstrated significant improvement in patient-reported outcomes at 1 year postoperatively. Moreover, a meta analysis published in 2022 demonstrated a significantly reduced retear rate among patch-augmented rotator cuff repairs as compared to isolated rotator cuff repairs.

CONCLUSION

Tissue augmentation can be performed efficiently and reproducibly to promote biologic healing of arthroscopic rotator cuff repairs. The specific biphasic cancellous allograft presented in this video may be a viable treatment adjunct in the setting of deficient greater tuberosity bone stock, revision cases, or impaired native enthesis healing; however, further research is needed to assess clinical outcomes associated with its use.

PATIENT CONSENT DISCLOSURE STATEMENT

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.