All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique

Abstract

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation.

All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results

“…On retrospective analysis, this patient was the patient with the lower amount of pre-operative forward flexion (30) and highest pre-operative pain scores (9). She had persistent asymmetric strength and range of motion at most recent follow-up and had the largest limitation in forward flexion (90) and highest VAS pain score (7). Of note, this patient was not the patient who received workers' compensation.…”

“…Traditionally, an open approach was used to address these tears due to limitations in visualization and tissue mobilization [2,11,21,31]. More recently, several arthroscopic techniques have been described with favorable results [5,7,13,20,22,33,40]. A common theme among arthroscopic techniques designed to repair massive anterosuperior rotator cuff tears involves purposeful disruption of the rotator interval tissue to facilitate tendon excursion and mobilization [5,7,13,20,22,33,40].…”

“…More recently, several arthroscopic techniques have been described with favorable results [5,7,13,20,22,33,40]. A common theme among arthroscopic techniques designed to repair massive anterosuperior rotator cuff tears involves purposeful disruption of the rotator interval tissue to facilitate tendon excursion and mobilization [5,7,13,20,22,33,40]. Neer [32] described the rotator interval as the triangular area bound medially by the coracoid process, superiorly by the anterior edge of supraspinatus, and inferiorly by the superior edge of subscapularis.…”

“Owl” Technique for All-Arthroscopic Augmentation of a Massive or Large Rotator Cuff Tear With Extracellular Matrix Graft

“…The challenges involved include introduction and securing of augment, prevention of augment from bunching up, and prevention of sutures from becoming tangled. 4,5 Our technique addresses these challenges. The described technique involves relatively few suture limbs; therefore, augment introduction is straightforward with a reduced risk of suture ends becoming tangled.…”

“…One approach that has gained popularity is the use of extracellular matrixederived material to augment the repair. [3][4][5] Arthroscopic augmentation, however, is technically challenging, difficult to reproduce consistently, and time-consuming. Part of this challenge is because of the difficulties in introducing and securing the augment in the desired orientation.…”