Rotator Cuff Tears: Biologic Tuberoplasty With a Biologic Skin Graft as a Permanent Spacer Animation

Rotator Cuff Tears: Biologic Tuberoplasty With a Biologic Skin Graft as a Permanent Spacer Animation

This animation demonstrates a biologic tuberoplasty using a biologic skin graft for the treatment of a rotator cuff tear. A biologic tuberoplasty is used to treat a massive rotator cuff tear that cannot be repaired. This surgical technique involves shaving down the greater tuberosity, which is a bony bump on top of the upper arm bone called the humerus, where 3 of the 4 rotator cuff tendons attach.

Adding a skin graft on top provides a cushion between the top of the upper arm bone and the front-facing part of the shoulder blade, called the acromion, to reduce bone-on-bone friction during shoulder movement. Here, we see a right shoulder with the front of the shoulder facing the right side of the screen. Surgical instruments will be passed through a plastic tube, called a cannula, that is inserted into the shoulder to perform the procedure.

The top of the upper arm bone is first shaved down. The prepared area is measured and used to size the skin graft, which will be made slightly smaller because the graft will stretch. Sutures are secured onto the 2 bottom corners of the graft, while sutures are simply passed through the top 2 corners of the graft, leaving a loop at the free ends.

Next, 2 soft body anchors are inserted into the top corners of the prepared area of the upper arm bone. These anchors are already threaded with sutures. Two of the sutures from both anchors are pulled out of the shoulder through the cannula. The 2 blue sutures from the anchors are passed through the suture loops that have already been threaded through the top corners of the skin graft.

The free ends of these blue sutures are then passed through the black and white suture loops from the anchors, applying tension to these black and white sutures threads the blue sutures into the anchors without having to tie knots. The graft is folded in half and pulled into the shoulder through the cannula. The graft is positioned over the prepared bone, and the sutures at the top of the graft are tightened to secure the graft in place.

Next, the sutures at the bottom of the graft are threaded through 2 hard body anchors. These anchors are placed in the bone to tack down the bottom of the graft to hold it in place. The blue suture tails from the first 2 anchors are cut, and the biologic tuberoplasty is complete.