Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair

ABSTRACT: Surgical repair of massive and chronic rotator cuff tears is difficult due to tendon retraction and severe atrophy, and the resultant retear rate in the structurally weak tendons is high. Commercially available patches and bioinductive scaffolds have been used to provide strength and superior healing environment in partial and complete rotator cuff tears. Biological biceps autograft has been used for superior capsular reconstruction, and the subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing. We describe our technique for combined use of the long biceps tendon (LBT) and vasculature-preserved subacromial bursa as autografts in rotator cuff repair augmentation. The technique involves obtaining a LBT graft of sufficient length using a “traction and tenodesis” technique. The subacromial bursa is mobilized as a continuous layer (vascular bursal duvet) by maintaining its medial and lateral vascularity. All-suture anchors are used to minimize the insertion apertures (3 mm) in tuberosity. The bursa is advanced laterally, and the mobilized cuff is repaired together as a biceps-cuff-bursa composite unit. Combined use of the biceps and bursa as biological autografts has the advantage of structural and regenerative augmentation, and the autografts are easily accessible without added cost. Technique Video Video 1 The surgical technique is demonstrated in a right shoulder in the beach-chair position. Sutures from subscapularis repair are passed around LBT, and the tendon is tenodesed after maximal intraarticular tractional pull. LBT is then detached just proximal to tenodesis sutures and the proximal stump is used as augmentation autograft. Next, the subacromial bursa is mobilized as a continuous layer and medial and lateral attachments of the bursal layer are preserved. A high posterolateral (HPL) portal is created and used for visualization throughout the procedure. Three all-suture anchors are inserted in a single-row configuration, and sutures are passed through the LBT-supraspinatus- bursa composite anteriorly, and through the infraspinatus-bursa complex posteriorly. Sliding knots are used to secure the biceps-cuff-bursa composite to the tuberosity. Dynamic flexion-extension and rotational assessment is finally performed to ensure correct tension on the composite repair.

SUBMITTER: Bhatia D 

PROVIDER: S-EPMC8556760 | biostudies-literature |

REPOSITORIES: biostudies-literature