Table 1.

Pearls and Pitfalls of Arthroscopic Biologic Acromiotuberoplasty

Pearls	Pitfalls
Fully prepare the subacromial space before graft advancement	In osteopenic bone, the medial-row anchors can be pulled out of bone when advancing the graft into the subacromial space. Consider using a grasper to deliver the graft close to the medial-row anchors instead of solely relying on pulling the sutures for graft advancing
A thorough exposure of the undersurface of the acromion and acromioclavicular joint facilitates suture passage for the acromial-sided graft	Avoid contact between the dermal allografts and skin to prevent contamination
Preserve the coracoacromial ligament at the anterior margin of the acromion to prevent anterosuperior humeral head escape	Bunching or slacking of the tuberosity-sided graft as the result of unequal anchor spacing or unequal tensioning
A smaller tuberosity-sided graft is easy to handle in the subacromial space. A 20- × 20-mm size works in most cases
Use a PassPort cannula with a divider for suture management during tuberosity-sided graft medial-row fixation
Sequentially tension the tuberosity-sided graft into place to avoid intra-articular bunching
Adjust the acromial-sided graft to be at the center of the acromial undersurface before final suture tying over the acromion