Cable Graft: Simple Superior Capsule Reconstruction Technique for Irreparable Rotator Cuff Tear Using a Teflon Patch

Fig 1. Picture and schematic of the Teflon patch penetrated by the first sutures. (A) The Teflon is tri-folded and 5 stitches passing through all layers are made per side, except on the side of the crease. (B) Sutures penetrate between the stitches, which have been prepared on the patch, and the upper layer (layer nearer the acromion). Finally, 4 sutures penetrate between the 5 stitches.

Fig 2. Posterolateral subacromial view of right shoulder. (A) Subacromial osteophytes are fully removed to prevent the graft from abrasion and tearing. The arrow shows the acromion from which osteophytes have been fully removed. (B) Soft tissue near the scapula neck is fully removed to ensure a visual field for graft insertion.

Fig 3. Posterolateral subacromial view of the right shoulder (A-B) and overall view from the cranial side of the right shoulder (C-D) lying in the left lateral decubitus position. (A) The size of the graft is determined by the measured distance from the anchor inserted into the scapular neck to the outer edge of the greater tuberosity. (B) Two anchors are inserted at the 11-o’clock and 1-o’clock positions, fixed with one suture tape and one strong suture each. (C-D) A posterior anchor is inserted at the posterior portal (C) and an anterior anchor is inserted at the anterior portal (D).

Fig 4. Overall view from the cranial side of the right shoulder and Teflon patch (A-D), and the posterolateral subacromial view of the right shoulder (E and F). (A) The portal is extended to 2 cm with a 15-mm diameter cannula. (B) Sutures are penetrated using a suture passer. The suture passer is inserted in the upper layer, that is the layer nearer the acromion. (C) All sutures (4 suture tapes and 4 strong sutures) from the anterolateral portal are penetrated inside the graft. One suture tape and one strong suture are paired and passed through one place. (D) The Teflon patch is grabbed with forceps and prepared for insertion. (E) The graft is twisted and sutures have slack just after insertion of the graft. (F) The graft is advanced until it reaches the glenoid fossa while pulling on the sutures to prevent the slack of the sutures. The position is adjusted so that the graft is stable. The graft is positioned between the rotator cuff and bone.

Fig 5. Overall view from the cranial side of the right shoulder (A) and posterolateral subacromial view of right shoulder (B-C). (A) A 10-mm diameter cannula is inserted in the 15-mm diameter cannula. The cannula is used to prevent excessive drainage and to prevent thread tangling. (B-C) The graft outer edge before (B) and after (C) anchor fixation is shown. Suture tape and strong sutures penetrating through the graft are observed at the outer edge of the graft (B). The sutures and graft are fixed by 2 anchors at the front and back.

Fig 6. The cable graft technique. The Teflon patch is secured to the glenoid and greater tuberosity without suturing and tying.

Fig 7. Radiography before and after surgery and coronal magnetic resonance imaging scan after surgery of the right shoulder. Shortening of AHD and humeral head migration were evident before surgery. They were improved postoperatively. (AHD, acromiohumeral distance.)