Arthroscopic Biologic Acromiotuberoplasty for Irreparable Rotator Cuff Tears

Abstract

Recent attention has turned toward the prevention of acromiohumeral abutment in the treatment of irreparable rotator cuff tears (IRCTs). This can be achieved through tendon transfer with a bridging allograft, superior capsular reconstruction, dermal allograft application to the greater tuberosity (biologic tuberoplasty), bursal acromial reconstruction, or subacromial balloon spacer placement. Recent literature has demonstrated increased graft thickness is associated with improved clinical outcomes after superior capsular reconstruction, suggesting a potential role of a direct bone-to-bone contact between the greater tuberosity and acromion in symptom generation in patients with IRCTs. In keeping with this ethos and building on the principle of both biologic tuberoplasty and bursal acromial reconstruction, the authors propose biologic acromiotuberoplasty as a treatment for IRCTs wherein a 3-mm dermal allograft is fixated to both the greater tuberosity of the humerus and the undersurface of the acromion for a total of 6 mm of allograft interposition.