Rooting Rotator Cuff Reconstruction for Irreparable Posterior-Superior Rotator Cuff Tear

Abstract

Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.

Crimped nanofiber scaffold mimicking tendon-to-bone interface for fatty-infiltrated massive rotator cuff repair

“…To stimulate this pathological state, a rabbit MRCT model was developed, in which most of the subscapularis, supraspinatus and infraspinatus tendons were removed from the tendinous insertion, leaving only a small amount of tendon tissue connecting the rotator cuff muscles. Peroneus longus tendon autografts, NS, and CNS3 were prepared for MRCT repair [ 37 ]. The tendon–humerus complexes were harvested 1 and 3 months after implantation for high-resolution micro-CT ( Fig.…”

Biomechanical and Histological Results of Dual-Suspensory Reconstruction Using Banded Tendon Graft to Bridge Massive Rotator Cuff Tears in a Chronic Rabbit Model

“…After being prepared in the same dimensions using specially designed surgical instruments in similar procedures (Figure 2E), the PT graft was used for dual-suspensory reconstruction (Figure 2F). 31,36,47,48…”

“…10,23,40,46 Surgeons have used a patch to bridge the gap between the retracted rotator cuff tendons and the humeral head, which restores the normal anatomic characteristics and force chain to the rotator cuff. 1,23,48 This technique introduces characteristic failure sites, including cuff-to-graft interface, graft substance, and graft-to-bone interface. 7,30 Therefore, the reportedly high failure rates of this technique, ranging from 20% to 74%, may be closely related to the patch fixation strategies at 2 interfaces and the patch materials themselves.…”

“…31,40,47,48 In this dual-suspensory technique, the banded tendon graft is passed through the rotator cuff tendons and folded back at the opposite side for medial suspensory fixation on the rotator cuff tendons, with the 2 graft ends pulled into 2 longitudinal humeral tunnels for lateral intratunnel suspensory fixation on the tuberosity. 31,40,47,48 However, it is unclear whether this technique using tendon grafts to bridge MRCTs has biomechanical and histological superiority over routine patch repair in terms of the formation of a stronger bridging structure in vivo.…”

The Plug-Type Patch Results in Immediate and Postoperative Advantages in Graft-to-Bone Integration for Bridging Massive Rotator Cuff Tears in a Chronic Rabbit Model

“…Inspired by intratunnel graft fixation strategies, such as conventional anterior cruciate ligament reconstruction, latissimus dorsi transfer, or rotator cuff reconstruction to treat MRCTs, 15,16,52,53 we propose a novel intratunnel technique for patch bony fixation on the humeral head. In this technique, the patch is correspondingly designed to the plug-type patch (Plug-Pat) for its easier application during the tunnel-based procedure, which may have some potential to improve immediate fixation strength and postoperative healing characteristics when transferring the routine bone surface fixation to the intratunnel fixation.…”