Compressed Biceps Autograft Augmentation of Arthroscopic Rotator Cuff Repair

Figures

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  Fig 1. Suprapectoral biceps harvest in right shoulder with patient in lateral decubitus position. (A) A triangle is drawn between the lateral midline portal and the anterosuperior portal (black arrows). A cannula is placed in the falciform portal (green arrow), which is established using a spinal needle for localization starting at the tip of the drawn triangle (dotted lines). The falciform portal overlies the bicipital groove. (B) Biceps tendon after tenodesis, with sutures coming from placed anchor. The cannula shown (sutures passing through) is the falciform portal. (C) Tenotomized biceps (red star) and intact falciform ligament (green star).

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  Fig 2. Biceps patch. (A) Twenty-seven millimeters of normal biceps tendon taken from biceps after tenodesis. The tendon is centered in the compressive plate device. It should be noted that the plate has an inset space for the tendon. (B) Compressive device with maximal compression placed. Once the desired compression has been obtained, the tendon is left under compression for 3 minutes. (C) Newly created patch. It should be noted that the tendon has been flattened to fill the entirety of the recessed space and measures approximately 25 mm in width.

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  Fig 3. Insertion of patch (red stars) in right shoulder with patient in lateral decubitus position. (A) Proprietary device. (B) Appearance of patch when first introduced with device rollers compressed together. (C) Once the patch is appropriately placed medial to lateral, the device is expanded and the patch is spread out on tension over the rotator cuff. The star represents the center of the patch, and lateral is to the left of the photo.

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  Fig 4. Fixation of biceps patch (red stars) in right shoulder with patient in lateral decubitus position. (A) Placement of first suture staple (purple), with stapler in place to fix second staple. (B) Fixation of anterior aspect of patch.

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  Fig 5. Final construct in right shoulder with patient in lateral decubitus position with viewing through lateral portal. The patch (red star) is shown in its final configuration. The patch is able to move as a unit with the repaired rotator cuff.