Arthroscopic Supraspinatus Tendon Reconstruction Using Hybrid LARS-Fascia Lata Graft for Irreparable Posterosuperior Massive Rotator Cuff Tears.

Background: . The present article describes a unique arthroscopic STR approach involving a hybrid LARS-fascia lata graft for irreparable posterosuperior MRCTs. Description: . Alternatives: Surgical alternatives for the treatment of irreparable posterosuperior MRCTs include partial repair, superior capsular reconstruction (SCR), tendon transfers (such as latissimus dorsi or pectoralis major transfer), and reverse shoulder arthroplasty. Rationale: , suggesting muscle revitalization potential. Expected Outcomes: , STR resulted in significant improvements in active shoulder range of motion. Additionally, outcome scores substantially improved compared with the preoperative baseline scores. The fascia lata enhances interface healing between the LARS ligament and bone, whereas the LARS component reduces the risk of graft failure. The hybrid LARS-fascia lata graft technique might achieve better long-term outcomes for patients with irreparable posterosuperior MRCTs. Important Tips: Subacromial decompression is critical for graft passage.Graft trajectory must follow a 30° to 45° angle to avoid impingement.Mattress sutures (2 cm) are used between the LARS artificial ligament and fascia lata to enhance the interface healing between the LARS artificial ligament and bone in the footprint.Maintain moderate tension in the LARS artificial ligament when its end is fixed to the scapular spine.Fractures of the medial scapular spine may easily occur during LARS artificial ligament fixation with a 2.9-mm LUPINE (DePuy Mitek) suture anchor. Acronyms and Abbreviations: VAS = visual analog scale scoreASES = American Shoulder and Elbow Surgeons scoreUCLA = University of California Los Angeles scoreROM = range of motionAHD = acromiohumeral distancePP = posterior portalAP = anterolateral portalLP = lateral accessory portalMRI = magnetic resonance imagingPDS = polydioxanone sutureBMI = body mass indexFF = forward flexionSBD = subacromial bursal decompressionER = external rotationIR = internal rotation.