Interposition Grafting Using Fascia Lata Autograft for Failed Rotator Cuff Repairs

Figures

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  Fig 1. Preoperative coronal (A) and sagittal (B) views of magnetic resonance imaging of the left shoulder. A huge rotator cuff tear (red circle) can be seen. The supraspinatus has obvious retraction (red arrow), and the screws in the humeral head are basically stable (blue circle).

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  Fig 2. The remaining screws and the suture on the left humeral head are cleared under arthroscope in the beach-chair position. Then, stability of the screws is tested to ensure that they are firmly embedded in the left humeral head and can be retained. The supraspinatus is found retracted, but some rotator cuff masses are still acceptable. (Posterolateral approach)

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  Fig 3. The top of a 5-mL syringe is cut off to create a sheath. The fascia lata from lateral thigh incision is created on the affected side, folded in half, and sutured into a 4 × 3-cm patch with reinforced stitches.

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  Fig 4. The 4 sutures (1-4) on the residual stump of the supraspinatus are passed through one end of the acromial fascia patch of the left shoulder, and the 8 sutures on the 2 anchors (7, 8) are evenly passed through the other end of the patch. Then, tears of subscapularis (5) and infraspinatus (6) are sutured with the patch (A). Subsequently, the sutures on the residual stump of the supraspinatus are tied and secured. After knotting the sutures of the same color on the anchor ends, 2 shoulder lateral PEEK (polyether ether ketone) screws (9, 10) are used to secure the remaining stitching for an increased coverage (B). (The observation approach is on the posterolateral approach, and the operation approach is on the anterolateral approach. Patient is in the beach-chair position.)

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  Fig 5. Four sutures are inserted on the side of the left supraspinatus (A) under arthroscope, and 2 internal threaded screws are inserted into the greater tuberosity of the left humerus (B). After pulling in and fixing the patch, the torn infraspinatus is sutured onto the patch and secured with a knot (C). The remaining suture is fixed with external rows of screws to enhance the coverage (D). (A, B, D: Posterolateral approaches, C: Anterolateral approaches)

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  Fig 6. The incision is sutured to end the procedure of the left shoulder in the beach-chair position.