Anterior Cable Reconstruction Using Semitendinosus Allograft for Large Rotator Cuff Defects

Figures

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  Fig 1. Left shoulder in the lateral decubitus position viewed from the posterolateral portal. (A) Triple-loaded 5.5-mm corkscrew anchor for the infraspinatus repair is deployed into the greater tuberosity footprint, and a single anchor repair using simple suture passes and knot tying is performed in this case. (B) The tendon with the underlying capsule is repaired to the sulcus. Arrows, infraspinatus tear margin. (A, anterior; P, posterior.)

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  Fig 2. Left shoulder in the lateral decubitus position viewed from the posterolateral portal. (A) Footprint of the greater tuberosity is prepared with a shaver or burr to create a trough to stimulate a healing response and mechanically support the anterior cable reconstruction allograft. (B) Anchor placed at sulcus cartilage margin, defining the anterior cable reconstruction procedure on the humeral side; notice the sutures are managed with sutures anteriorly (arrows) and sutures docked posteriorly (asterisks) in expectation of tying after the graft is passed into the subacromial space. The side-to-side sutures (hashtags) are docked accordingly as well, anterior and posterior. The knotless repair and shuttle sutures are in view (circle), ready to pass the graft. (A, anterior; P, posterior.)

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  Fig 3. (A) Semitendinosus allograft is prepared and tensioned on the back table (9-mm folded-over diameter). (B) Repair sutures (mattress configuration in this case) placed at the same measured glenoid anchor distance. (C) Glenoid anchor locations (arrows) viewed from the posterolateral portal of a left shoulder with the patient in a lateral decubitus position.

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  Fig 4. Left shoulder in the lateral decubitus position viewed from the posterolateral portal. (A) Side-to-side suture retensioning the native posterosuperior capsule to the graft using “loop-around” graft fixation. (B) One of 3 sutures used to loop around both graft limbs together. (G, graft; 1, anterior graft limb; 2, posterior graft limb.)

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  Fig 5. Left shoulder in the lateral decubitus position viewed from the anterolateral portal. Posterosuperior capsule functionality is restored with semitendinosus allograft anterior cable reconstruction. Note 3 side-to-side sutures (arrows) securing and retensioning the posterosuperior capsule to anterior cable graft. (PS, posterosuperior rotator cuff.)

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  Fig 6. Anterior cable reconstruction schematic of a right shoulder depicting capsular tissue (rotator cuff tendon and muscle subtracted) with dysfunctional superior capsule (arrows) (A) and restoration of underlying native capsule using side-to-side sutures (repairs the underlying posterosuperior capsule to the semitendinosus allograft anterior cable reconstruction construct), thus restoring the cable structure (arrows) (B). Fixation at the sulcus is mandatory to define an “anterior” cable reconstruction (attachment where the native capsule resides).