Semitendinosus Allograft Cable Reconstruction Technique for Massive Irreparable Rotator Cuff Tears

Abstract

Massive irreparable rotator cuff tears are difficult to treat. Disruption of the rotator cable and joint capsule leads to altered glenohumeral joint mechanics, superior migration of the humeral head, and limited overhead function. A few graft options exist for reconstruction, with limited outcomes data. A newer technique using a hamstring allograft provides benefits compared with other graft reconstruction options. This Technical Note describes a rotator cable reconstruction using a V-shaped hamstring allograft for treatment of a massive, irreparable rotator cuff tear.

Arthroscopic superior capsule reconstruction augmentation using a semitendinosus autograft in massive reparable rotator cuff tears

“…Graft options for augmentation include fascia lata, 40 LHBT, 36 semitendinosus tendon, 9 and acellular dermal allografts. 15 The selection of the LHBT as an autograft source is convincing owing to its anatomy being similar to that of the anterior cable and the common pathology of rotator cuff tears, which are usually treated with tenotomy or tenodesis.…”

“…Recent studies have demonstrated that the semitendinosus tendon has several advantages as a graft option for ARCR reinforcement. 9 , 17 , 47 First, the semitendinosus tendon is a standard graft source due to the harvesting technique, sufficient length and strength, and minimal donor-site morbidity. Biomechanically, the hamstring has been described as a static stabilizer that allows sufficient centering of the humeral head.…”

“…Recent studies demonstrated the biomechanical and technical feasibility of using the semitendinosus tendon in SCR for irreparable rotator cuff tears. 3 , 9 , 13 , 17 , 47 The semitendinosus tendon has potential advantages, including simple manipulation and management for secure and anatomical repair because of its cord-like morphology. A graft long enough to be folded can be designed based on the size and location of rotator cuff tears.…”

A Technique for a Suture-Based Cable Reconstruction of an Irreparable Posterosuperior Rotator Cuff Tear

“… 11 These tears directly affect normal biomechanics by disrupting active and passive restraints. 12 While several treatment options have been described for these tears, the failure rate remains unacceptably high. 11 , 13 , 14 Therefore, it is imperative for surgeons to improve treatment strategies for the treatment of MIRCTs to obtain better postoperative outcomes.…”

“…Other joint-preserving procedures, including superior capsule reconstruction and cable reconstruction, have been proposed to treat MIRCTs. 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 However, our technique presents some advantages, including less surgical time, it is technically easier, and potential cost savings. A disadvantage is that as the rotator cuff is not repaired completely, our technique may not be preferable for young and active patients where the risk of progression is of greater concern.…”