Abstract / Summary
Background: Conventional techniques for repairing an irreparable posterosuperior massive rotator cuff tear (MRCT) typically fail1,2. The supraspinatus tendon reconstruction (STR) technique offers a systematic approach to achieve both anatomic restoration and functional recovery of the supraspinatus tendon1. The use of autografts for reconstruction is challenged by their limited availability, inadequate dimensions, and donor site morbidity. The Ligament Augmentation and Reconstruction System (LARS; MovMedix) is a synthetic ligament consisting of fibers made of polyethylene terephthalate that is used as an alternative to autograft; however, concerns remain regarding inadequate graft integration with bone3. In contrast, fascia lata autografts demonstrate enhanced interface healing with both the supraspinatus muscle and the bone at the footprint4-6. The present article describes a unique arthroscopic STR approach involving a hybrid LARS-fascia lata graft for irreparable posterosuperior MRCTs.
Description: The patient is placed in the lateral decubitus position, with lateral traction applied to the operative arm. Following diagnostic arthroscopy and subacromial decompression, the dimensions of the rotator cuff defect are measured arthroscopically. The width of the LARS artificial ligament is matched to the defect size, and the length is determined by the distance from the greater tuberosity to the most medial aspect of the scapular spine. A 5-cm autogenous fascia lata graft is harvested from the ipsilateral proximal thigh (distal to a point 2 cm above the greater trochanter). The graft is then circumferentially wrapped around one end of the LARS ligament and sutured in a mattress suture pattern. Two absorbable anchors are placed on the medial line of the footprint. The anchors are sutured through the lateral end of the hybrid LARS-fascia lata graft. The guide pin is passed through the subacromial region from the lateral portal, running along the supraspinatus muscle to the most medial part of the spine of the scapula and penetrating the dorsal skin. The traction wire is pulled medially and fixed with use of a double-row anchor technique. A transverse incision approximately 3 cm in length is made at the most medial side of the scapular spine to expose the medial end of the patch and the spine of the scapula. A suture anchor is implanted at the most medial part of the scapular spine, and the fascia lata is sutured to maintain the graft under as much tension as possible7-9.
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.