Contents

Videos

Preface

Contributors

1 Single-Row Rotator Cuff Repair Using Graft Augmentation and Bone Marrow Aspirate Concentrate Augmentation

Anand Murthi and Manesha Lankachandra

1.1 Patient Positioning

1.2 Portal Placement

1.3 Surgical Technique

1.4 Rehabilitation

1.5 Rationale and Evidence for Approach

2 SCOI Row Rotator Cuff Repair?A Medial Row, Tension-Free, Triple-Loaded, Crimson Duvet?Augmented Rotator Cuff Repair

Eric Tannenbaum, John Taylor, Stephen Snyder, and Michael Bahk

2.1 Patient Positioning

2.2 Portal Placement

2.2.1 Posterior Midglenoid Portal (PMGP)

2.2.2 Anterior Midglenoid Portal (AMGP)

2.2.3 Midlateral Subacromial Portal (MLSP)

2.3 Surgical Technique

2.4 Surgeon Tips and Tricks

2.5 Pitfalls/Complications

2.6 Rehabilitation

2.7 Rationale and/or Evidence for Approach

3 Single-Row Undersurface All-Inside Rotator Cuff Repair

Ashleigh Elkins and George A.C. Murrell

3.1 Patients Selected for Surgery

3.2 Patient Positioning

3.3 Patient Preparation

3.4 Posterior Portal Placement

3.5 Initial Diagnostic Shoulder Arthroscopy

3.6 Creation of the Lateral Portal

3.7 Preparation of the Tendon and Landing Site

3.8 Arthroscopic Suturing

3.9 Preparing and Deploying Suture Anchors

3.10 Closing

3.11 Rehabilitation

3.12 Six-Month Review

3.13 Rationale for the Technique

3.14 Advantages of the Technique

3.15 Disadvantages

3.16 Conclusion

4 Double-Row Repair with Biceps Tendon Augmentation

Jeffrey S. Abrams and Tertuliano Vieira

4.1 Examination under Anesthesia 23

4.2 Positioning

4.3 Portal Placement

4.4 Surgical Technique

4.5 Surgical Benefits

4.6 Avoid Pitfalls and Complications

4.7 Rehabilitation

4.8 Rationale and Benefits

5 Double Row with ?Rip-Stop? Rotator Cuff Repair

Mark R. Wilson, Eric D. Field, and Larry D. Field

5.1 Patient Positioning

5.2 Portal Placement

5.3 Surgical Technique

5.4 Surgeon Tips and Tricks

5.5 Pitfalls/Complications

5.6 Rehabilitation

5.7 Rationale and/or Evidence for Approach

6 SpeedBridge Repair of Massive Rotator Cuff Tears Using Provisional Traction Suture Reducing Anchor and Bioinductive Bovine Augment Patch

Hithem Rahmi, Sevag Bastian, and John Itamura

6.1 Positioning

6.1.1 Lateral Decubitus Position

6.2 Portal Placement

6.2.1 Standard Portals

6.3 Surgical Technique

6.3.1 Initial Portal Placement

6.3.2 Subacromial Access/Assessment

6.3.3 Preparation of the Rotator Cuff Footprint

6.3.4 Perform Soft Tissue Releases

6.3.5 Traction Sutures

6.3.6 Placement of Provisional Traction Suture Reducing Anchor

6.3.7 Perform a Repair Using the SpeedBridge (Arthrex) with the Medial Seal Technique

6.3.8 Placement of Bioinductive Bovine Augment Patch

6.4 Surgeon Tips and Tricks

6.4.1 Visualization

6.4.2 Traction Stitch

6.4.3 Medial Seal

6.4.4 SpeedBridge Preparation

6.4.5 Dog-Ear

6.4.6 Patch Augment

6.5 Pitfalls/Complications

6.5.1 Medial Seal Failure

6.5.2 Failure of Repair

6.6 Rehabilitation

6.7 Rationale and/or Evidence for Approach

7 Two-Anchor, Double-Row Rotator Cuff Repair with Incorporated Biceps Tenodesis

Michael J. O?Brien and Felix H. Savoie

7.1 Patient Positioning

7.2 Portal Placement

7.3 Surgical Technique (Step-by-Step Approach)

7.3.1 Posterior Viewing Portal

7.3.2 Lateral Viewing Portal

7.3.3 Repair

7.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

7.5 Pitfalls/Complications

7.6 Rehabilitation

7.7 Rationale and/or Evidence for Approach

8 Arthroscopic Transosseous Equivalent Rotator Cuff Repair: Key Points of Surgical Technique

Thomas ?Quin? Throckmorton

8.1 Operative Technique: Patient positioning

8.2 Portal Placement

8.3 Surgical Technique

8.4 Surgeon Tips and Tricks

8.5 Pitfalls and Complications

8.6 Rehabilitation

8.7 Literature Review

9 Arthroscopic Double-Row Transosseous Equivalent Repair of Large Rotator Cuff Tears

Ajay S. Padaki, Daniel J. Song, Pinkawas Kongmalai, and William N. Levine

9.1 Patient Positioning

9.1.1 Standard Supine Beach Chair Positioning

9.2 Portal Placement

9.2.1 Posterior

9.2.2 Anterior

9.2.3 Lateral

9.3 Surgical Technique (Step-by-Step Approach)

9.3.1 Diagnostic Arthroscopy from the Posterior Portal

9.3.2 Subacromial Space

9.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

9.5 Pitfalls/Complications

9.6 Rehabilitation

9.7 Rationale and/or Evidence for Approach

9.7.1 Repair Technique

9.7.2 Postoperative Therapy

10 Arthroscopic Rotator Cuff Repair Using a Suture-Bridge Technique and Associated Open Subpectoral Biceps Tenodesis

Catherine M. Rapp, Alexander Vara, Brett P. Wiater, and J. Michael Wiater

10.1 Patient Positioning

10.2 Portal and Incision Placement

10.3 Surgical Technique Step-by-Step

10.4 Surgeon Tips and Tricks

10.5 Pitfalls/Complications

10.6 Rehabilitation

10.7 Rationale

11 Transosseous Repair

J. Gabriel Horneff and Mark D. Lazarus

11.1 Patient Positioning

11.2 Portal Placement

11.3 Surgical Technique (Step-by-Step Approach)

11.4 Surgeon Tips and Tricks

11.5 Pitfalls/Complications

11.6 Rehabilitation

11.7 Rationale and/or Evidence for Approach

12 True Transosseous Hybrid Rotator Cuff Repair

Brett Sanders

12.1 Patient Positioning

12.2 Portal Placement

12.3 Surgical Technique (Hybrid Cuff Repair)

12.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

12.5 Pitfalls/Complications

12.6 Rationale and/or Evidence for Approach

13 All-Arthroscopic Anchorless Transosseous Rotator Cuff Repair

Aydin Budeyri, Raffaele Garofalo, and Sumant ?Butch? Krishnan

13.1 Case and Scope

14 Fully Arthroscopic Transosseous Rotator Cuff Repair: A Reverse-Guided Technique

Jean Kany

14.1 Patient Positioning and Portals 90

14.2 Surgical Technique

14.2.1 Debride and Prepare the Footprint

14.2.2 Deploy the Instrument

14.3 Surgeon Tips and Tricks

14.4 Pitfalls/Complications

14.4.1 Rehabilitation

14.4.2 Rationale and/or Evidence for Approach

14.5 Conclusion

15 Double-Row Subscapularis Repair for Full-Thickness Subscapularis Tears

Grant Garcia, Hailey Casebolt, and Anthony Romeo

15.1 Patient Positioning

15.2 Portal Placement

15.2.1 Portal Placement Technique

15.3 Surgical Technique (Step-by-Step Approach)

15.3.1 Steps

15.3.2 Tips

15.3.3 Inferior Medial Anchor Placement

15.3.4 Superior Medial Suture Placement

15.4 Surgeon Tips and Tricks

15.4.1 Tips

15.4.2 Instruments

15.4.3 Knots

15.5 Pitfalls/Complications

15.6 Rehabilitation

15.7 Rationale and/or Evidence for Approach

15.8 Conclusion

16 Arthroscopic Single-Row Subscapularis Tendon Repair

Howard D. Routman and Jack E. Kazanjian

16.1 Patient Positioning

16.2 Surgical Technique

16.3 Surgeon Tips and Tricks

16.4 Post-Op Rehabilitation

16.5 Rationale and Evidence

17 Arthroscopic Single Row Subscapularis Repair

Michael Bender and Hussein Elkousy

17.1 Patient Positioning

17.2 Portal Placement

17.3 Surgical Technique

17.3.1 Diagnostic Arthroscopy

17.3.2 Subacromial Assessment and Decompression

17.3.3 Biceps Management

17.3.4 Anterior Bursectomy and Tear Mobilization

17.3.5 Tuberosity Preparation and Anchor Placement

17.3.6 Suture Passage and Tendon Repair

17.4 Surgeon Tips and Tricks

17.5 Pitfalls and Complications

17.5.1 Missed Tears

17.5.2 Complete and Retracted Tears. 140

17.5.3 Re-Tear

17.5.4 Infection

17.6 Rehabilitation

17.7 Rationale and Evidence for Approach

18 Arthroscopic Repair of Subscapularis Tear Based on the Tear Types

Chris Hyunchul Jo and Jeong Yong Yoon

18.1 Patient Positioning

18.2 Portal Placement

18.3 Surgical Technique (Step-by-Step Approach)

18.3.1 Partial Tear in the Leading Edge

18.3.2 Articular-Sided Tear

18.3.3 Concealed Bursal-Sided Tear

18.3.4 Subscapularis Tendon Tear with Supraspinatus Tendon Tear

18.3.5 Isolated Subscapularis Tendon Tear

18.3.6 Biological Augmentation with Platelet-Rich Plasma (PRP) and Multiple Channeling

18.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

18.5 Pitfalls/Complications

18.6 Rehabilitation

19 Arthroscopic Transtendon Double-Row Subscapularis Repair with all Suture Medial Row Anchors

Robert A. Duerr, Tyler J. Hunt, and Laurence D. Higgins

19.1 Patient Positioning

19.2 Portal Placement

19.3 Surgical Technique (Step-by-Step Approach)

19.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

19.5 Pitfalls and Complications

19.6 Rehabilitation

19.7 Rationale and Evidence for Approach

20 Four-Anchor Repair of Massive Subscapularis Tear with Subcoracoid Decompression

Colin P. Murphy, Colin M. Robbins, Connor G. Ziegler, Anthony Sanchez, and Matthew T. Provencher

20.1 Patient Positioning

20.2 Portal Placement

20.3 Surgical Technique

20.4 Surgeon Tips and Tricks

20.5 Pitfalls/Complications

20.6 Rehabilitation

20.7 Rationale and/or Evidence for Approach

21 Superior Capsular Reconstruction with Fascia Lata Autograft

Teruhisa Mihata

21.1 Patient Positioning

21.2 Portal Placement

21.3 Surgical Technique

21.3.1 Measurement of Defect Size

21.3.2 Deciding on Graft Size

21.3.3 Harvesting the Fascia Lata and Making the Autograft

21.3.4 Treatment of Associated Lesions

21.3.5 Acromioplasty

21.3.6 Anchor Placement on the Superior Glenoid

21.3.7 Anchor Placement on the Medial Footprint

21.3.8 Insertion of Fascia Lata into the Subacromial Space

21.3.9 Attachment to the Greater Tuberosity

21.3.10 Side-to-Side Suturing between the Graft and the Infraspinatus Tendon or Teres Minor

21.4 Surgeon Tips and Tricks

21.5 Pitfalls/Complications

21.6 Rehabilitation

21.7 Rationale and Evidence for Fascia Lata SCR

22 Superior Capsular Reconstruction with Allograft

David M. Dines, Michael C. Fu, and Joshua S. Dines

22.1 Patient Positioning

22.2 Portal Placement

22.3 Surgical Technique

22.4 Surgeon Tips and Tricks

22.5 Pitfalls/Complications

22.6 Rehabilitation

22.7 Rationale and/or Evidence for Approach

23 Superior Capsular Reconstruction with Porcine Xenograft

Ruth A. Delaney and Daniel B.L. Garcia

23.1 Patient Positioning

23.2 Portal Placement

23.3 Surgical Technique

23.3.1 Key Steps

23.3.2 Tips and Tricks

23.4 Pitfalls, Complications

23.5 Rehabilitation

23.5.1 Phase 1

23.5.2 Phase 2

23.5.3 Phase 3

23.5.4 Phase 4

23.6 Rationale and Evidence

23.6.1 Outcomes?Unpublished Data

23.6.2 SCR Data

23.6.3 DX Matrix Graft

23.6.4 Evidence Supporting our Rehabilitation Protocol

24 All-Arthroscopic Superior Capsular Reconstruction with Dermal Allograft

Sriram Sankaranarayanan, Frances Cuomo, and Konrad I. Gruson

24.1 Patient Positioning

24.2 Portal Placement

24.3 Surgical Technique

24.4 Surgeon Tips and Tricks

24.5 Rehabilitation

24.6 Rationale and Evidence for Approach

25 Subpectoral Biceps Tenodesis

Jacob M. Kirsch and Michael T. Freehill

25.1 Patient Positioning and Planning the Surgical Approach 193

25.2 Surgical Technique

25.2.1 Surgical Exposure

25.2.2 Placing the Suture Anchor

25.2.3 Arthroscopic Portal Placement 194

25.2.4 Initiate Shoulder Arthroscopy

25.2.5 Completing the Tenodesis

25.2.6 Wound Closure

25.3 Tips and Tricks

25.4 Pitfalls and Complications

25.5 Rehabilitation

25.6 Rationale for Approach

26 Identifying and Exposing the Proximal Biceps in Its Groove: The ?Slit? Technique

Mark R. Wilson, Eric D. Field, and Larry D. Field

26.1 Patient Positioning

26.2 Portal Placement

26.3 Surgical Technique

26.4 Surgeon Tips and Tricks

26.5 Pitfalls/Complications

26.6 Rehabilitation

26.7 Rationale and/or Evidence for Approach

27 Arthroscopic Suprapectoral Biceps Tenodesis with Lasso Loop

Kyle A. Borque and Jon J.P. Warner

27.1 Patient Positioning

27.2 Portal Placement

27.3 Surgical Technique (step-by-step approach)

27.4 Surgeon Tips and Tricks

27.5 Pitfalls/Complications

27.6 Rehabilitation

27.7 For the Rationale and/or Evidence for the Approach

28 Transosseous Arthroscopic Biceps Tenodesis

Brett Sanders

28.1 Patient Positioning

28.2 Portal Placement

28.3 Surgical Technique

28.4 Tips and Tricks

28.5 Pearls and Pitfalls

28.6 Rehabilitation

28.7 Rationale

29 Revision Rotator Cuff Repair and Techniques for Mobilization

Joseph N. Liu, Anirudh K. Gowd, Brandon C. Cabarcas, Grant H. Garcia, and Nikhil N. Verma

29.1 Patient Positioning

29.2 Portal Placement

29.3 Surgical Technique (Step-by-Step Approach)

29.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

29.5 Pitfalls/Complications

29.6 Rehabilitation

29.7 Rationale and/or Evidence for Approach

30 Arthroscopic Transosseous Revision Rotator Cuff Repair

Jeremy Smalley and Uma Srikumaran

30.1 Patient Positioning

30.2 Portal Placement

30.3 Surgical Technique

30.3.1 Diagnostic Arthroscopy

30.3.2 Bursectomy, Debridement, Removal of Loose Implants, Footprint Preparation, Cuff Mobilization (if Needed)

30.3.3 Tunneling and Suture Shuttling 219

30.3.4 Suture Passage Through the Cuff

30.3.5 Suture Tying

30.4 Surgeon Tips and Tricks

30.5 Pitfalls/Complications

30.6 Rehabilitation

30.7 Rationale and Evidence of Approach

31 Biological Augmentation of Rotator Cuff Repair with Platelet-Rich Plasma and Multiple Channeling

Paul Shinil Kim and Chris Hyunchul Jo

31.1 Patient Positioning

31.2 Portal Placement

31.2.1 Posterior Portal

31.2.2 Anterior Portal

31.2.3 Lateral Portal (50-Yard Line View)

31.2.4 Posterolateral Portal (Grand Canyon View)

31.3 Surgical Technique (Step-by-Step Approach)

31.3.1 Exploration for the Glenohumeral Joint

31.3.2 Management of the Biceps Tendon

31.3.3 Preparation for the Tendon Repair

31.3.4 Arthroscopic Repair

31.4 Surgeon Tips and Tricks (Use of Specific Instrumentation)

31.4.1 Platelet-Rich Plasma Augmentation

31.4.2 Multiple Channeling

31.5 Pitfalls/Complications

31.6 Rehabilitation

32 Load-Sharing Rip-Stop and Knotless Rip-Stop Repairs for Massive Rotator Cuff Tears

Matthew P. Noyes and Patrick J. Denard

32.1 Patient Positioning

32.2 Portal Placement

32.2.1 Posterior Portal

32.2.2 Anterosuperolateral Portal

32.2.3 Lateral Portal

32.2.4 Percutaneous Portals

32.3 Surgical Technique

32.3.1 Load-Sharing Rip-Stop

32.3.2 Knotless Rip-Stop

32.4 Tips and Tricks

32.5 Complications

32.6 Rehabilitation

32.7 Literature

33 Arthroscopically Assisted Lower Trapezius Transfer for Irreparable: Posterosuperior Rotator Cuff Tears

Joaquin Sanchez-Sotelo and Bassem T. Elhassan

33.1 Introduction

33.2 Patient Positioning

33.3 Portal Placement

33.4 Surgical Technique

33.4.1 Partial Cuff Repair and Biceps Tenotomy/Tenodesis if Indicated

33.4.2 Achilles Tendon Allograft Preparation

33.5 Lower Trapezius Tendon Harvesting and Mobilization

33.6 Allograft Passage and Fixation to the Greater Tuberosity

33.6.1 Trapezius to Allograft Repair

33.7 Tips and Tricks

33.8 Pitfalls and Complications

33.9 Rehabilitation

33.10 Rationale and Evidence

33.11 Conclusion

34 Subacromial Balloon Spacer for Irreparable Cuff Tears

J. Gabriel Horneff III and Joseph A. Abboud

34.1 Patient Positioning

34.2 Portal Placement

34.3 Surgical Technique (Step-by-Step Approach)

34.4 Surgeon Tips and Tricks

34.5 Pitfalls/Complications

34.6 Rehabilitation

34.7 Rationale and/or Evidence for Approach

35 Acellular Human Dermal Allograft Rotator Cuff Reconstruction

Michael Bahk, Stephen Snyder, and J. Ryan Taylor

35.1 Patient Positioning

35.2 Portal Placement

35.3 Surgical Technique

35.3.1 Preoperative Preparation (Back Table)

35.3.2 Shoulder Arthroscopic Evaluation, Debridement, Decompression, and Preparation

35.3.3 Placement of First Suture Anchor

35.3.4 Placement of Second Anchor and Performing the Biceps Tenodesis Using the ThRevo ?Italian Loop? Method

35.3.5 Measuring the Defect in the Rotator Cuff

35.3.6 Preparation of the Graft (Back Table)

35.3.7 Attachment of the Graft to the Posteromedial Cuff

35.3.8 Alternative Method?Direct Suture Passing

35.3.9 Attachment of the Graft to the Anterior Cuff and Biceps Tendon

35.3.10 Deliver the Graft into the Shoulder Joint

35.3.11 Tying of the Remaining Sutures from the Anchors

35.3.12 Suturing the Lateral Graft to Bone

35.3.13 Insert Third/Fourth Anchors

35.3.14 Tying the Anchored Sutures

35.3.15 Evaluate the Repair

35.4 Surgeon Tips and Tricks

35.5 Pitfalls/Complications

35.6 Postoperative Care

35.7 Rationale and/or Evidence for Approach

35.7.1 Methods

35.7.2 Results

35.7.3 Conclusion

36 A Comparison of the Outcomes of Two Types of Synthetic Patches for Interpositional Graft Use in Irreparable Rotator Cuff Tears

Tom Morrison, Patrick H. Lam, and George A.C. Murrell

36.1 Introduction

36.2 Methods

36.2.1 Study Design

36.2.2 Surgical Procedures

36.2.3 Patient-Ranked Outcomes

36.2.4 Examiner-Ranked Outcomes

36.2.5 Statistical Analysis

36.3 Results

36.3.1 Matching for Tear Size between Patch Groups

36.3.2 Direct-Repair Comparison Group

36.3.3 Matching for Tear Size between Patch Groups and Direct-Repair Groups

36.3.4 Demographics

36.3.5 Intraoperative data

36.3.6 Patient-Ranked Outcomes

36.3.7 Strength

36.4 Discussion

36.5 Conclusion

37 Dermal Augmentation for Challenging Large and Massive Rotator Cuff Tears

Devon T. Brameier and Paul M. Sethi

37.1 Patient Positioning

37.2 Portal Placement

37.3 Surgical Technique

37.4 Surgeon Tips and Tricks

37.5 Pitfalls/Complications

37.6 Rehabilitation

37.7 Rationale and/or Evidence for Approach

37.7.1 Biological Healing Rationale

37.7.2 Mechanical Support Rationale

37.7.3 Indications for Dermal Augmentation of Rotator Cuff Repairs

37.7.4 Clinical Evidence for the Use of Dermal Augmentation in Rotator Cuff Repair

38 Case Discussions on Surgical Decision Making for Massive Rotator Cuff Tears: Repair, Reconstruction, or Reverse Shoulder Replacement?

Mark Frankle and Mark Mighell

Index