Contents
Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
1 Single-Row Rotator Cuff Repair Using Graft Augmentation and
Bone Marrow Aspirate Concentrate Augmentation . . . . . . . . . . . . . . . 1
Anand Murthi and Manesha Lankachandra
1.1 Patient Positioning . . . . . . . . . 1
1.2 Portal Placement . . . . . . . . . . 1
1.3 Surgical Technique . . . . . . . . . 2
1.4 Rehabilitation . . . . . . . . . . . . 3
1.5 Rationale and Evidence for
Approach. . . . . . . . . . . . . . . . 3
2 SCOIRowRotatorCuff Repair—AMedial Row, Tension-Free,
Triple-Loaded, Crimson Duvet–Augmented Rotator Cuff Repair. . . . . . 6
Eric Tannenbaum, John Taylor, Stephen Snyder, and Michael Bahk
2.1 Patient Positioning . . . . . . . . . 6
2.2 Portal Placement . . . . . . . . . . 7
2.2.1 Posterior Midglenoid Portal
(PMGP) . . . . . . . . . . . . . . . . . 7
2.2.2 Anterior Midglenoid Portal
(AMGP) . . . . . . . . . . . . . . . . . 7
2.2.3 Midlateral Subacromial Portal
(MLSP). . . . . . . . . . . . . . . . . . 8
2.3 Surgical Technique . . . . . . . . . 8
2.4 Surgeon Tips and Tricks. . . . . . 10
2.5 Pitfalls/Complications. . . . . . . 11
2.6 Rehabilitation . . . . . . . . . . . . 11
2.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 12
3 Single-Row Undersurface All-Inside Rotator Cuff Repair . . . . . . . . . . . 14
Ashleigh Elkins and George A.C. Murrell
3.1 Patients Selected for Surgery . . 14
3.2 Patient Positioning . . . . . . . . . 14
3.3 Patient Preparation . . . . . . . . 14
3.4 Posterior Portal Placement . . . 14
3.5 Initial Diagnostic Shoulder
Arthroscopy. . . . . . . . . . . . . . 15
3.6 Creation of the Lateral Portal . 15
3.7 Preparation of the Tendon and
Landing Site . . . . . . . . . . . . . . 15
3.8 Arthroscopic Suturing. . . . . . . 17
3.9 Preparing and Deploying
Suture Anchors . . . . . . . . . . . 17
3.10 Closing . . . . . . . . . . . . . . . . . 17
3.11 Rehabilitation . . . . . . . . . . . . 18
3.12 Six-Month Review . . . . . . . . . 18
3.13 Rationale for the Technique . . 18
3.14 Advantages of the
Technique . . . . . . . . . . . . . . . 20
3.15 Disadvantages. . . . . . . . . . . . 21 3.16 Conclusion . . . . . . . . . . . . . . 21
4 Double-Row Repair with Biceps Tendon Augmentation. . . . . . . . . . . 23
Jeffrey S. Abrams and Tertuliano Vieira
4.1 Examination under Anesthesia 23
4.2 Positioning . . . . . . . . . . . . . . 23
4.3 Portal Placement . . . . . . . . . . 23
4.4 Surgical Technique. . . . . . . . . 23
4.5 Surgical Benefits . . . . . . . . . . 26
4.6 Avoid Pitfalls and
Complications . . . . . . . . . . . . 28
4.7 Rehabilitation . . . . . . . . . . . . 28
4.8 Rationale and Benefits . . . . . . 28
5 Double Row with “Rip-Stop” Rotator Cuff Repair. . . . . . . . . . . . . . . . . 30
Mark R. Wilson, Eric D. Field, and Larry D. Field
5.1 Patient Positioning . . . . . . . . 30
5.2 Portal Placement . . . . . . . . . . 30
5.3 Surgical Technique. . . . . . . . . 30
5.4 Surgeon Tips and Tricks . . . . . 33
5.5 Pitfalls/Complications . . . . . . 34
5.6 Rehabilitation . . . . . . . . . . . . 35
5.7 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 35
6 SpeedBridge Repair of Massive Rotator Cuff Tears Using
Provisional Traction Suture Reducing Anchor and Bioinductive
Bovine Augment Patch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Hithem Rahmi, Sevag Bastian, and John Itamura
6.1 Positioning . . . . . . . . . . . . . . 36
6.1.1 Lateral Decubitus Position . . . 36
6.2 Portal Placement . . . . . . . . . . 36
6.2.1 Standard Portals . . . . . . . . . . 36
6.3 Surgical Technique. . . . . . . . . 37
6.3.1 Initial Portal Placement . . . . . 37
6.3.2 Subacromial
Access/Assessment . . . . . . . . 38
6.3.3 Preparation of the Rotator Cuff
Footprint. . . . . . . . . . . . . . . . 38
6.3.4 Perform Soft Tissue Releases . . 38
6.3.5 Traction Sutures . . . . . . . . . . 38
6.3.6 Placement of Provisional
Traction Suture Reducing
Anchor . . . . . . . . . . . . . . . . . 39
6.3.7 Perform a Repair Using the
SpeedBridge (Arthrex) with the
Medial Seal Technique . . . . . . 40
6.3.8 Placement of Bioinductive
Bovine Augment Patch . . . . . . 42
6.4 Surgeon Tips and Tricks . . . . . 42
6.4.1 Visualization . . . . . . . . . . . . . 42
6.4.2 Traction Stitch . . . . . . . . . . . . 43
6.4.3 Medial Seal . . . . . . . . . . . . . . 43
6.4.4 SpeedBridge Preparation . . . . 43
6.4.5 Dog-Ear . . . . . . . . . . . . . . . . 44
6.4.6 Patch Augment . . . . . . . . . . . 44
6.5 Pitfalls/Complications . . . . . . 44
6.5.1 Medial Seal Failure. . . . . . . . . 44
6.5.2 Failure of Repair . . . . . . . . . . 44
6.6 Rehabilitation . . . . . . . . . . . . 44 6.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 45
7 Two-Anchor, Double-Row Rotator Cuff Repair with Incorporated
Biceps Tenodesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Michael J. O’Brien and Felix H. Savoie
7.1 Patient Positioning . . . . . . . . . 46
7.2 Portal Placement . . . . . . . . . . 46
7.3 Surgical Technique
(Step-by-Step Approach). . . . . 47
7.3.1 Posterior Viewing Portal. . . . . 47
7.3.2 Lateral Viewing Portal . . . . . . 47
7.3.3 Repair . . . . . . . . . . . . . . . . . . 48
7.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation) . . . . 50
7.5 Pitfalls/Complications. . . . . . . 51
7.6 Rehabilitation . . . . . . . . . . . . 51
7.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 51
8 Arthroscopic Transosseous Equivalent Rotator Cuff Repair: Key
Points of Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Thomas “Quin” Throckmorton
8.1 Operative Technique: Patient
positioning . . . . . . . . . . . . . . 53
8.2 Portal Placement . . . . . . . . . . 54
8.3 Surgical Technique . . . . . . . . . 54
8.4 Surgeon Tips and Tricks. . . . . . 56
8.5 Pitfalls and Complications. . . . 56
8.6 Rehabilitation . . . . . . . . . . . . 56
8.7 Literature Review. . . . . . . . . . 57
9 Arthroscopic Double-Row Transosseous Equivalent Repair of
Large Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Ajay S. Padaki, Daniel J. Song, Pinkawas Kongmalai, and William N. Levine
9.1 Patient Positioning . . . . . . . . . 58
9.1.1 Standard Supine Beach Chair
Positioning . . . . . . . . . . . . . . 58
9.2 Portal Placement . . . . . . . . . . 58
9.2.1 Posterior . . . . . . . . . . . . . . . . 58
9.2.2 Anterior. . . . . . . . . . . . . . . . . 59
9.2.3 Lateral . . . . . . . . . . . . . . . . . . 59
9.3 Surgical Technique
(Step-by-Step Approach). . . . . 59
9.3.1 Diagnostic Arthroscopy from
the Posterior Portal . . . . . . . . 59
9.3.2 Subacromial Space . . . . . . . . . 59
9.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation) . . . . 60
9.5 Pitfalls/Complications. . . . . . . 60
9.6 Rehabilitation . . . . . . . . . . . . 61
9.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 61
9.7.1 Repair Technique . . . . . . . . . . 61
9.7.2 Postoperative Therapy . . . . . . 61
10 Arthroscopic Rotator Cuff Repair Using a Suture-Bridge Technique
and Associated Open Subpectoral Biceps Tenodesis . . . . . . . . . . . . . . 63
Catherine M. Rapp, Alexander Vara, Brett P. Wiater, and J. Michael Wiater
10.1 Patient Positioning . . . . . . . . 63
10.2 Portal and Incision
Placement. . . . . . . . . . . . . . . 65
10.3 Surgical Technique
Step-by-Step . . . . . . . . . . . . . 66
10.4 Surgeon Tips and Tricks . . . . . 71
10.5 Pitfalls/Complications . . . . . . 72
10.6 Rehabilitation . . . . . . . . . . . . 72
10.7 Rationale. . . . . . . . . . . . . . . . 73
11 Transosseous Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
J. Gabriel Horneff and Mark D. Lazarus
11.1 Patient Positioning . . . . . . . . 76
11.2 Portal Placement . . . . . . . . . . 76
11.3 Surgical Technique
(Step-by-Step Approach) . . . . 77
11.4 Surgeon Tips and Tricks . . . . . 79
11.5 Pitfalls/Complications . . . . . . 80
11.6 Rehabilitation . . . . . . . . . . . . 80
11.7 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 80
12 True Transosseous Hybrid Rotator Cuff Repair . . . . . . . . . . . . . . . . . . . 82
Brett Sanders
12.1 Patient Positioning . . . . . . . . 82
12.2 Portal Placement . . . . . . . . . . 82
12.3 Surgical Technique (Hybrid Cuff
Repair) . . . . . . . . . . . . . . . . . 83
12.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation). . . . 84
12.5 Pitfalls/Complications . . . . . . 85
12.6 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 85
13 All-Arthroscopic Anchorless Transosseous Rotator Cuff Repair . . . . 88
Aydin Budeyri, Raffaele Garofalo, and Sumant “Butch” Krishnan
13.1 Case and Scope . . . . . . . . . . . 88
14 Fully Arthroscopic Transosseous Rotator Cuff Repair:
A Reverse-Guided Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Jean Kany
14.1 Patient Positioning and Portals 90
14.2 Surgical Technique. . . . . . . . . 91
14.2.1 Debride and Prepare the Footprint
. . . . . . . . . . . . . . . . . . . 91
14.2.2 Deploy the Instrument. . . . . . 92
14.3 Surgeon Tips and Tricks . . . . . 93
14.4 Pitfalls/Complications . . . . . . 93
14.4.1 Rehabilitation . . . . . . . . . . . . 93
14.4.2 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 93
14.5 Conclusion . . . . . . . . . . . . . . 94
15 Double-Row Subscapularis Repair for Full-Thickness
Subscapularis Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Grant Garcia, Hailey Casebolt, and Anthony Romeo
15.1 Patient Positioning . . . . . . . . . 96
15.2 Portal Placement . . . . . . . . . . 97
15.2.1 Portal Placement Technique . . 98
15.3 Surgical Technique
(Step-by-Step Approach). . . . . 98
15.3.1 Steps . . . . . . . . . . . . . . . . . . . 98
15.3.2 Tips . . . . . . . . . . . . . . . . . . . . 101
15.3.3 Inferior Medial Anchor
Placement . . . . . . . . . . . . . . . 101
15.3.4 Superior Medial Suture
Placement . . . . . . . . . . . . . . . 102
15.4 Surgeon Tips and Tricks. . . . . . 105
15.4.1 Tips . . . . . . . . . . . . . . . . . . . . 105
15.4.2 Instruments. . . . . . . . . . . . . . 105
15.4.3 Knots. . . . . . . . . . . . . . . . . . . 106
15.5 Pitfalls/Complications. . . . . . . 106
15.6 Rehabilitation . . . . . . . . . . . . 106
15.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 106
15.8 Conclusion. . . . . . . . . . . . . . . 108
16 Arthroscopic Single-Row Subscapularis Tendon Repair. . . . . . . . . . . . 109
Howard D. Routman and Jack E. Kazanjian
16.1 Patient Positioning . . . . . . . . . 109
16.2 Surgical Technique . . . . . . . . . 109
16.3 Surgeon Tips and Tricks. . . . . . 112
16.4 Post-Op Rehabilitation . . . . . . 112
16.5 Rationale and Evidence . . . . . . 112
17 Arthroscopic Single Row Subscapularis Repair . . . . . . . . . . . . . . . . . . . 114
Michael Bender and Hussein Elkousy
17.1 Patient Positioning . . . . . . . . . 114
17.2 Portal Placement . . . . . . . . . . 115
17.3 Surgical Technique . . . . . . . . . 117
17.3.1 Diagnostic Arthroscopy . . . . . 117
17.3.2 Subacromial Assessment and
Decompression . . . . . . . . . . . 120
17.3.3 Biceps Management . . . . . . . . 122
17.3.4 Anterior Bursectomy and Tear
Mobilization . . . . . . . . . . . . . 125
17.3.5 Tuberosity Preparation and
Anchor Placement . . . . . . . . . 127
17.3.6 Suture Passage and Tendon
Repair . . . . . . . . . . . . . . . . . . 129
17.4 Surgeon Tips and Tricks. . . . . . 132
17.5 Pitfalls and Complications. . . . 139
17.5.1 Missed Tears . . . . . . . . . . . . . 139
17.5.2 Complete and Retracted Tears. 140
17.5.3 Re-Tear . . . . . . . . . . . . . . . . . 142
17.5.4 Infection . . . . . . . . . . . . . . . . 143
17.6 Rehabilitation . . . . . . . . . . . . 144
17.7 Rationale and Evidence for
Approach. . . . . . . . . . . . . . . . 144
18 Arthroscopic Repair of Subscapularis Tear Based on
the Tear Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Chris Hyunchul Jo and Jeong Yong Yoon
18.1 Patient Positioning . . . . . . . . 146
18.2 Portal Placement . . . . . . . . . . 146
18.3 Surgical Technique
(Step-by-Step Approach) . . . . 147
18.3.1 Partial Tear in the Leading
Edge . . . . . . . . . . . . . . . . . . . 147
18.3.2 Articular-Sided Tear. . . . . . . . 147
18.3.3 Concealed Bursal-Sided Tear . 147
18.3.4 Subscapularis Tendon Tear
with Supraspinatus Tendon
Tear . . . . . . . . . . . . . . . . . . . 147
18.3.5 Isolated Subscapularis Tendon
Tear . . . . . . . . . . . . . . . . . . . 148
18.3.6 Biological Augmentation with
Platelet-Rich Plasma (PRP) and
Multiple Channeling . . . . . . . 148
18.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation). . . . 149
18.5 Pitfalls/Complications . . . . . . 149
18.6 Rehabilitation . . . . . . . . . . . . 149
19 Arthroscopic Transtendon Double-Row Subscapularis Repair
with all Suture Medial Row Anchors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Robert A. Duerr, Tyler J. Hunt, and Laurence D. Higgins
19.1 Patient Positioning . . . . . . . . 151
19.2 Portal Placement . . . . . . . . . . 151
19.3 Surgical Technique
(Step-by-Step Approach) . . . . 151
19.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation). . . . 152
19.5 Pitfalls and Complications . . . 153
19.6 Rehabilitation . . . . . . . . . . . . 153
19.7 Rationale and Evidence for
Approach . . . . . . . . . . . . . . . 154
20 Four-Anchor Repair of Massive Subscapularis Tear with
Subcoracoid Decompression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Colin P. Murphy, Colin M. Robbins, Connor G. Ziegler, Anthony Sanchez, and
Matthew T. Provencher
20.1 Patient Positioning . . . . . . . . 156
20.2 Portal Placement . . . . . . . . . . 156
20.3 Surgical Technique. . . . . . . . . 156
20.4 Surgeon Tips and Tricks . . . . . 159
20.5 Pitfalls/Complications . . . . . . 160
20.6 Rehabilitation . . . . . . . . . . . . 160
20.7 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 162
21 Superior Capsular Reconstruction with Fascia Lata Autograft . . . . . 163
Teruhisa Mihata
21.1 Patient Positioning . . . . . . . . 163
21.2 Portal Placement . . . . . . . . . . 163
21.3 Surgical Technique. . . . . . . . . 163
21.3.1 Measurement of Defect Size . . 163
21.3.2 Deciding on Graft Size . . . . . . 164
21.3.3 Harvesting the Fascia Lata and
Making the Autograft . . . . . . . 165
21.3.4 Treatment of Associated
Lesions . . . . . . . . . . . . . . . . . 165
21.3.5 Acromioplasty . . . . . . . . . . . . 165
21.3.6 Anchor Placement on the
Superior Glenoid . . . . . . . . . . 165
21.3.7 Anchor Placement on the
Medial Footprint . . . . . . . . . . 167
21.3.8 Insertion of Fascia Lata into the
Subacromial Space . . . . . . . . . 167
21.3.9 Attachment to the Greater
Tuberosity . . . . . . . . . . . . . . . 168
21.3.10 Side-to-Side Suturing between
the Graft and the Infraspinatus
Tendon or Teres Minor . . . . . . 169
21.4 Surgeon Tips and Tricks. . . . . . 169
21.5 Pitfalls/Complications. . . . . . . 170
21.6 Rehabilitation . . . . . . . . . . . . 170
21.7 Rationale and Evidence for
Fascia Lata SCR . . . . . . . . . . . . 170
22 Superior Capsular Reconstruction with Allograft . . . . . . . . . . . . . . . . . 174
David M. Dines, Michael C. Fu, and Joshua S. Dines
22.1 Patient Positioning . . . . . . . . . 174
22.2 Portal Placement . . . . . . . . . . 174
22.3 Surgical Technique . . . . . . . . . 174
22.4 Surgeon Tips and Tricks. . . . . . 176
22.5 Pitfalls/Complications. . . . . . . 176
22.6 Rehabilitation . . . . . . . . . . . . 176
22.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 177
23 Superior Capsular Reconstruction with Porcine Xenograft . . . . . . . . 178
Ruth A. Delaney and Daniel B.L. Garcia
23.1 Patient Positioning . . . . . . . . . 178
23.2 Portal Placement . . . . . . . . . . 178
23.3 Surgical Technique . . . . . . . . . 178
23.3.1 Key Steps . . . . . . . . . . . . . . . . 179
23.3.2 Tips and Tricks . . . . . . . . . . . . 183
23.4 Pitfalls, Complications . . . . . . 184
23.5 Rehabilitation . . . . . . . . . . . . 185
23.5.1 Phase 1 . . . . . . . . . . . . . . . . . 185
23.5.2 Phase 2 . . . . . . . . . . . . . . . . . 186
23.5.3 Phase 3 . . . . . . . . . . . . . . . . . 186
23.5.4 Phase 4 . . . . . . . . . . . . . . . . . 186
23.6 Rationale and Evidence . . . . . . 186
23.6.1 Outcomes—Unpublished Data. . 186
23.6.2 SCR Data . . . . . . . . . . . . . . . . 187
23.6.3 DX Matrix Graft . . . . . . . . . . . 187
23.6.4 Evidence Supporting our
Rehabilitation Protocol . . . . . . 187
24 All-Arthroscopic Superior Capsular Reconstruction with
Dermal Allograft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Sriram Sankaranarayanan, Frances Cuomo, and Konrad I. Gruson
24.1 Patient Positioning . . . . . . . . . 188
24.2 Portal Placement . . . . . . . . . . 188
24.3 Surgical Technique . . . . . . . . . 188
24.4 Surgeon Tips and Tricks. . . . . . 190
24.5 Rehabilitation . . . . . . . . . . . . 190
24.6 Rationale and Evidence for
Approach. . . . . . . . . . . . . . . . 190
25 Subpectoral Biceps Tenodesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Jacob M. Kirsch and Michael T. Freehill
25.1 Patient Positioning and
Planning the Surgical Approach 193
25.2 Surgical Technique. . . . . . . . . 193
25.2.1 Surgical Exposure . . . . . . . . . 193
25.2.2 Placing the Suture Anchor . . . 194
25.2.3 Arthroscopic Portal Placement 194
25.2.4 Initiate Shoulder
Arthroscopy . . . . . . . . . . . . . 194
25.2.5 Completing the Tenodesis . . . 194
25.2.6 Wound Closure . . . . . . . . . . . 195
25.3 Tips and Tricks. . . . . . . . . . . . 195
25.4 Pitfalls and Complications . . . 195
25.5 Rehabilitation . . . . . . . . . . . . 196
25.6 Rationale for Approach . . . . . 196
26 Identifying and Exposing the Proximal Biceps in Its Groove: The
“Slit” Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Mark R. Wilson, Eric D. Field, and Larry D. Field
26.1 Patient Positioning . . . . . . . . 198
26.2 Portal Placement . . . . . . . . . . 198
26.3 Surgical Technique. . . . . . . . . 198
26.4 Surgeon Tips and Tricks . . . . . 202
26.5 Pitfalls/Complications . . . . . . 203
26.6 Rehabilitation . . . . . . . . . . . . 203
26.7 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 204
27 Arthroscopic Suprapectoral Biceps Tenodesis with Lasso Loop . . . . 205
Kyle A. Borque and Jon J.P. Warner
27.1 Patient Positioning . . . . . . . . 205
27.2 Portal Placement . . . . . . . . . . 205
27.3 Surgical Technique
(step-by-step approach). . . . . 205
27.4 Surgeon Tips and Tricks . . . . . 206
27.5 Pitfalls/Complications . . . . . . 206
27.6 Rehabilitation . . . . . . . . . . . . 206
27.7 For the Rationale and/or
Evidence for the Approach . . . 206
28 Transosseous Arthroscopic Biceps Tenodesis. . . . . . . . . . . . . . . . . . . . . 207
Brett Sanders
28.1 Patient Positioning . . . . . . . . 207
28.2 Portal Placement . . . . . . . . . . 207
28.3 Surgical Technique. . . . . . . . . 207
28.4 Tips and Tricks. . . . . . . . . . . . 208
28.5 Pearls and Pitfalls . . . . . . . . . 208
28.6 Rehabilitation . . . . . . . . . . . . 208
28.7 Rationale. . . . . . . . . . . . . . . . 208
29 Revision Rotator Cuff Repair and Techniques for Mobilization . . . . . 210
Joseph N. Liu, Anirudh K. Gowd, Brandon C. Cabarcas, Grant H. Garcia, and Nikhil N. Verma
29.1 Patient Positioning . . . . . . . . 210 29.2 Portal Placement . . . . . . . . . . 210
29.3 Surgical Technique
(Step-by-Step Approach). . . . . 210
29.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation) . . . . 213
29.5 Pitfalls/Complications. . . . . . . 213
29.6 Rehabilitation . . . . . . . . . . . . 214
29.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 214
30 Arthroscopic Transosseous Revision Rotator Cuff Repair . . . . . . . . . . 217
Jeremy Smalley and Uma Srikumaran
30.1 Patient Positioning . . . . . . . . . 217
30.2 Portal Placement . . . . . . . . . . 217
30.3 Surgical Technique . . . . . . . . . 218
30.3.1 Diagnostic Arthroscopy . . . . . 218
30.3.2 Bursectomy, Debridement,
Removal of Loose Implants,
Footprint Preparation, Cuff
Mobilization (if Needed) . . . . . 218
30.3.3 Tunneling and Suture Shuttling 219
30.3.4 Suture Passage Through the
Cuff . . . . . . . . . . . . . . . . . . . . 219
30.3.5 Suture Tying . . . . . . . . . . . . . 221
30.4 Surgeon Tips and Tricks. . . . . . 221
30.5 Pitfalls/Complications. . . . . . . 222
30.6 Rehabilitation . . . . . . . . . . . . 222
30.7 Rationale and Evidence of
Approach. . . . . . . . . . . . . . . . 222
31 Biological Augmentation of Rotator Cuff Repair with Platelet-Rich
Plasma and Multiple Channeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Paul Shinil Kim and Chris Hyunchul Jo
31.1 Patient Positioning . . . . . . . . . 224
31.2 Portal Placement . . . . . . . . . . 224
31.2.1 Posterior Portal . . . . . . . . . . . 224
31.2.2 Anterior Portal. . . . . . . . . . . . 224
31.2.3 Lateral Portal (50-Yard Line
View) . . . . . . . . . . . . . . . . . . 224
31.2.4 Posterolateral Portal (Grand
Canyon View). . . . . . . . . . . . . 224
31.3 Surgical Technique
(Step-by-Step Approach). . . . . 225
31.3.1 Exploration for the
Glenohumeral Joint . . . . . . . . 225
31.3.2 Management of the Biceps
Tendon . . . . . . . . . . . . . . . . . 225
31.3.3 Preparation for the Tendon
Repair . . . . . . . . . . . . . . . . . . 225
31.3.4 Arthroscopic Repair . . . . . . . . 226
31.4 Surgeon Tips and Tricks (Use of
Specific Instrumentation) . . . . 226
31.4.1 Platelet-Rich Plasma
Augmentation . . . . . . . . . . . . 226
31.4.2 Multiple Channeling. . . . . . . . 226
31.5 Pitfalls/Complications. . . . . . . 227
31.6 Rehabilitation . . . . . . . . . . . . 227
32 Load-Sharing Rip-Stop and Knotless Rip-Stop Repairs for Massive
Rotator Cuff Tears. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Matthew P. Noyes and Patrick J. Denard
32.1 Patient Positioning . . . . . . . . . 229 32.2 Portal Placement . . . . . . . . . . 229
32.2.1 Posterior Portal . . . . . . . . . . . 229
32.2.2 Anterosuperolateral Portal . . . 229
32.2.3 Lateral Portal. . . . . . . . . . . . . 230
32.2.4 Percutaneous Portals . . . . . . . 230
32.3 Surgical Technique. . . . . . . . . 230
32.3.1 Load-Sharing Rip-Stop . . . . . . 230
32.3.2 Knotless Rip-Stop . . . . . . . . . 232
32.4 Tips and Tricks. . . . . . . . . . . . 233
32.5 Complications . . . . . . . . . . . . 233
32.6 Rehabilitation . . . . . . . . . . . . 234
32.7 Literature . . . . . . . . . . . . . . . 234
33 Arthroscopically Assisted Lower Trapezius Transfer for Irreparable:
Posterosuperior Rotator Cuff Tears. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Joaquin Sanchez-Sotelo and Bassem T. Elhassan
33.1 Introduction . . . . . . . . . . . . . 235
33.2 Patient Positioning . . . . . . . . 236
33.3 Portal Placement . . . . . . . . . . 236
33.4 Surgical Technique. . . . . . . . . 237
33.4.1 Partial Cuff Repair and Biceps
Tenotomy/Tenodesis if
Indicated. . . . . . . . . . . . . . . . 237
33.4.2 Achilles Tendon Allograft
Preparation . . . . . . . . . . . . . . 237
33.5 Lower Trapezius Tendon
Harvesting and Mobilization. . 237
33.6 Allograft Passage and Fixation
to the Greater Tuberosity . . . . 238
33.6.1 Trapezius to Allograft Repair. . 239
33.7 Tips and Tricks. . . . . . . . . . . . 239
33.8 Pitfalls and Complications . . . 240
33.9 Rehabilitation . . . . . . . . . . . . 241
33.10 Rationale and Evidence . . . . . 241
33.11 Conclusion . . . . . . . . . . . . . . 242
34 Subacromial Balloon Spacer for Irreparable Cuff Tears . . . . . . . . . . . . 243
J. Gabriel Horneff III and Joseph A. Abboud
34.1 Patient Positioning . . . . . . . . 243
34.2 Portal Placement . . . . . . . . . . 243
34.3 Surgical Technique
(Step-by-Step Approach) . . . . 243
34.4 Surgeon Tips and Tricks . . . . . 245
34.5 Pitfalls/Complications . . . . . . 245
34.6 Rehabilitation . . . . . . . . . . . . 246
34.7 Rationale and/or Evidence for
Approach . . . . . . . . . . . . . . . 246
35 Acellular Human Dermal Allograft Rotator Cuff Reconstruction . . . 248
Michael Bahk, Stephen Snyder, and J. Ryan Taylor
35.1 Patient Positioning . . . . . . . . 248
35.2 Portal Placement . . . . . . . . . . 248
35.3 Surgical Technique. . . . . . . . . 248
35.3.1 Preoperative Preparation
(Back Table) . . . . . . . . . . . . . 248
35.3.2 Shoulder Arthroscopic
Evaluation, Debridement,
Decompression, and
Preparation . . . . . . . . . . . . . . 248
35.3.3 Placement of First Suture
Anchor . . . . . . . . . . . . . . . . . 249
35.3.4 Placement of Second Anchor
and Performing the Biceps
Tenodesis Using the ThRevo
“Italian Loop” Method . . . . . . 250
35.3.5 Measuring the Defect in the
Rotator Cuff . . . . . . . . . . . . . . 250
35.3.6 Preparation of the Graft
(Back Table) . . . . . . . . . . . . . . 250
35.3.7 Attachment of the Graft to the
Posteromedial Cuff . . . . . . . . . 251
35.3.8 Alternative Method—Direct
Suture Passing . . . . . . . . . . . . 251
35.3.9 Attachment of the Graft to the
Anterior Cuff and Biceps
Tendon . . . . . . . . . . . . . . . . . 252
35.3.10 Deliver the Graft into the
Shoulder Joint . . . . . . . . . . . . 252
35.3.11 Tying of the Remaining Sutures
from the Anchors . . . . . . . . . . 253
35.3.12 Suturing the Lateral Graft to
Bone . . . . . . . . . . . . . . . . . . . 253
35.3.13 Insert Third/Fourth Anchors . . 253
35.3.14 Tying the Anchored Sutures . . 253
35.3.15 Evaluate the Repair. . . . . . . . . 253
35.4 Surgeon Tips and Tricks. . . . . . 253
35.5 Pitfalls/Complications. . . . . . . 254
35.6 Postoperative Care . . . . . . . . . 255
35.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 255
35.7.1 Methods . . . . . . . . . . . . . . . . 255
35.7.2 Results. . . . . . . . . . . . . . . . . . 255
35.7.3 Conclusion. . . . . . . . . . . . . . . 256
36 A Comparison of the Outcomes of Two Types of Synthetic Patches
for Interpositional Graft Use in Irreparable Rotator Cuff Tears . . . . . 258
Tom Morrison, Patrick H. Lam, and George A.C. Murrell
36.1 Introduction. . . . . . . . . . . . . . 258
36.2 Methods . . . . . . . . . . . . . . . . 259
36.2.1 Study Design . . . . . . . . . . . . . 259
36.2.2 Surgical Procedures . . . . . . . . 259
36.2.3 Patient-Ranked Outcomes. . . . 261
36.2.4 Examiner-Ranked Outcomes. . 261
36.2.5 Statistical Analysis . . . . . . . . . 261
36.3 Results. . . . . . . . . . . . . . . . . . 261
36.3.1 Matching for Tear Size between
Patch Groups . . . . . . . . . . . . . 261
36.3.2 Direct-Repair Comparison
Group . . . . . . . . . . . . . . . . . . 261
36.3.3 Matching for Tear Size between
Patch Groups and
Direct-Repair Groups . . . . . . . 262
36.3.4 Demographics . . . . . . . . . . . . 262
36.3.5 Intraoperative data. . . . . . . . . 263
36.3.6 Patient-Ranked Outcomes. . . . 264
36.3.7 Strength . . . . . . . . . . . . . . . . 265
36.4 Discussion . . . . . . . . . . . . . . . 268
36.5 Conclusion. . . . . . . . . . . . . . . 269
37 Dermal Augmentation for Challenging Large and Massive Rotator
Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Devon T. Brameier and Paul M. Sethi
37.1 Patient Positioning . . . . . . . . . 271
37.2 Portal Placement . . . . . . . . . . 271
37.3 Surgical Technique . . . . . . . . . 271
37.4 Surgeon Tips and Tricks. . . . . . 272
37.5 Pitfalls/Complications. . . . . . . 277
37.6 Rehabilitation . . . . . . . . . . . . 278
37.7 Rationale and/or Evidence for
Approach. . . . . . . . . . . . . . . . 278
37.7.1 Biological Healing Rationale . . 280
37.7.2 Mechanical Support
Rationale . . . . . . . . . . . . . . . . 280
37.7.3 Indications for Dermal
Augmentation of Rotator Cuff
Repairs . . . . . . . . . . . . . . . . . 280
37.7.4 Clinical Evidence for the Use of
Dermal Augmentation in
Rotator Cuff Repair . . . . . . . . 281
38 Case Discussions on Surgical Decision Making for Massive Rotator
Cuff Tears: Repair, Reconstruction, or Reverse Shoulder
Replacement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Mark Frankle and Mark Mighell
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289