Rotator Cuff Tears: Biologic Tuberoplasty

Rotator Cuff Tears: Biologic Tuberoplasty

This surgical video demonstrates a biologic tuberoplasty using a biologic skin graft for the treatment of a massive irreparable rotator cuff tear. This surgical technique involves shaving down the greater tuberosity, a bony bump on the top of the upper arm bone, or humerus. Adding a biologic skin graft on top provides a cushion between the upper arm bone and the front-facing part of the shoulder blade, called the acromion. This helps reduce bone-on-bone friction where the rotator cuff tendon is no longer attached.

Here, we see a right shoulder from the side. The front of the shoulder is at the right side of the screen and the back of the shoulder is at the left side of the screen. The surgeon has already made small incisions into the shoulder, called portals, and inserted plastic tubes, called cannulas, that will be used to pass surgical instruments in and out of the shoulder. Here, we see an inside view of the shoulder from an arthroscopic camera. Much of the top of the upper arm bone is bare because the rotator cuff tendon has torn off from the bone.

The surgeon inserts a measuring device into the shoulder to measure the size of the exposed bone where the graft will be placed and uses a shaver to smooth out the top of the bone. The surgeon prepares the graft by tying sutures onto the 2 bottom corners of the graft and passing sutures through the top 2 corners of the graft, leaving a loop at the free ends. The graft is made slightly smaller than the measured area of the upper arm bone because the graft will stretch.

Next, the surgeon inserts 2 soft-body anchors through the skin into the top corners of the prepared area of the upper arm bone. These anchors are already threaded with sutures. The sutures from both anchors are pulled out of the shoulder through the cannula. The blue sutures from the anchors are passed through the suture loops 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 sutures threads the blue sutures into the anchors without having to tie knots.

The surgeon folds the graft in half and applies tension to the sutures from the anchors to pull the graft into the shoulder through the cannula. Here, you can see the graft positioned over the prepared upper arm bone. Next, the sutures at the bottom of the graft are threaded through 2 hard-body anchors, which are placed over each suture to tack down the bottom of the graft to hold it in place. Here, you can see the finished product, with the graft covering the top of the upper arm bone and secured in place with anchors. The surgeon applies final tension to the sutures to further tighten the graft down. Excess sutures are cut off, and the biologic tuberoplasty is complete.