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

Abstract

Despite the vast improvement in techniques and technology for arthroscopic rotator cuff surgery, repairs of massive and large tears remain challenging because they are associated with significantly high failure rates. In recent years, patch augmentation has gained popularity as a technique to decrease these high failure rates. Arthroscopic patch augmentation of rotator cuff repair, however, is technically difficult. The purpose of this report is to describe a simple and reproducible technique for all-arthroscopic extracellular matrix graft augmentation. With this technique, which we refer to as the "owl" technique because the prepared extracellular augment resembles an owl, there are relatively few suture ends involved; therefore, augment introduction is straightforward with a reduced risk of suture ends becoming tangled. In addition, the way in which our augmentation is prepared helps to prevent it from becoming bunched up when being secured.

The “Pull-Over” Technique for All Arthroscopic Rotator Cuff Repair With Extracellular Matrix Augmentation

“…We have previously described a technique for this procedure, which addressed some of the challenges involved ("owl" technique). 3 In addition, we have also previously reported a technique for arthroscopic superior capsular reconstruction, which again in our opinion simplified the procedure ("pull-over" technique for superior capsular reconstruction). 4 The purpose of this Technical Note is to describe a technique for arthroscopic rotator cuff repair with augmentation, which involves a combination of steps in both the "owl" technique for augmentation and the "pull-over" technique for superior capsular reconstruction.…”

“…This step is the same as that of the "owl technique" with a critical difference that, in addition, a free suture is also passed through the tendon (Fig 1, Video 1, Table 3). 3 The owl technique for arthroscopic rotator cuff repair with augmentation involves performing a standard medial row repair and then shaping the augment ("owl shaped") in a way that minimizes risks of the patch folding up. The patch is then stabilized laterally by inserting 2 lateral row anchors, but there is no medial stabilization of the augment.…”

“…The patch is then stabilized laterally by inserting 2 lateral row anchors, but there is no medial stabilization of the augment. 3 A standard medial row repair of the tendon tear is performed using either 1 or 2 medial row anchors with steps that include mobilization of the tendon, preparation of the foot print area on the greater tuberosity, insertion of the medial row anchors (Healicoil Peek, Smith and Nephews, Andover, MA), and passage of the anchor suture limbs through the tendon using a standard suture passer device (we have used the Scorpion device, Arthrex, Naples, FL). In addition, a free suture (FiberWire Number 2, Arthrex) is also passed through the tendon and brought out through the Neviaser port (Fig 1, Video 1).…”

“…In a similar manner to the "owl" technique, the corners of the rectangular patch are cut so one is left with an octagon (Fig 2). 3…”

<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

“…48 In other retrospective case series on large and massive tears, failure rates for acellular dermal allografts are between 10% and 40%, with all showing improved clinical outcomes compared to preoperative evaluation. [48][49][50][51][52][53] Furthermore, in a systematic review of different types of scaffolds, D'Ambrosi et al found that allografts had the lowest retear rate (16.4%). 54 Synthetic scaffolds are advantageous for their mechanical strength and decreased risk of disease transmission.…”