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Free biceps tendon autograft to augment arthroscopic rotator cuff repair.

ABSTRACT: Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while one is performing rotator cuff surgery. A subpectoral biceps tenodesis provides a source of autograft to augment rotator cuff repairs of all sizes. Two techniques are presented to augment rotator cuff repairs with a free biceps tendon autograft. This is a novel idea in an attempt to improve healing rates and long-term results of rotator cuff repairs of all sizes.

SUBMITTER: Obma PR

PROVIDER: S-EPMC3882703 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Free biceps tendon autograft to augment arthroscopic rotator cuff repair.

Obma Padraic R PR

Arthroscopy techniques 20131101 4

Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while on ...[more]

PMID: 24400197

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Project description:Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors. Technique Video Video 1 Arthroscopic repair of a right shoulder rotator cuff repair, subpectoral open biceps tenodesis, and autograft biceps graft augmentation is performed in a beach-chair position. We begin with a diagnostic arthroscopy viewing the subacromial space through the posterolateral portal. The rotator cuff tear is evaluated using a grasper through the lateral portal. The rotator cuff is repaired using a knotless configuration double row transosseous-equivalent beginning with all-suture anchors being placed, creating a medial row. These sutures are then passed through the rotator cuff tear and brought to a lateral row where the final construct is visualized. Next, we perform a mini-open subpectoral biceps tenodesis using a low axillary incision. The proximal biceps tendon is harvested and placed on the back table to be measured for autograft augmentation. The biceps autograft is placed in a compression plate and loaded into the press, where it is “smashed.” Sutures are put into all 4 corners of the graft and loaded onto the delivery device. The patch is inserted into the shoulder through a cannulated lateral portal into the subacromial space and deployed over the rotator cuff repair. The patch is fixated medially using a PLGA tissue tack device and laterally with two anchors. The final repair construct is demonstrated by the autograft patch augmentation lying flush over the rotator cuff repair.

Dataset Information

Free biceps tendon autograft to augment arthroscopic rotator cuff repair.

Publications

Free biceps tendon autograft to augment arthroscopic rotator cuff repair.

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