Table 3.

Surgical Steps

1.Diagnostic arthroscopy of glenohumeral joint.

2.Arthroscope then introduced into the bursa.

3.Bursectomy performed.

4.Acromioplasty performed.

5.If acromioclavicular joint tenderness pre-operatively, ACJ excision carried out.

6.Rotator cuff tear mobilized.

7.Greater tuberosity prepared.

8.Distance between medial glenoid and cuff footprint measured.

9.Suture passed to measured length in LHB and 1 cm distal to this point tenotomy performed.

10.LHB stump secured to greater tuberosity footprint.

11.Insertion of 1-2 medial row anchors depending on the anatomy of the tear.

12.Anchor sutures passed through torn rotator cuff tendon (i.e., 4 passes with 1 anchor, 8 passes with 2 anchors).

13.In addition, a free suture is also passed through the tendon and brought out through the Neviaser port.

14.Once all the anchor suture limbs have been passed through the cuff, they are tied together using standard arthroscopic knot tying techniques.

15.It is, however, critical not to tie any knots in the free FiberWire suture.

16.The distance between the anterior and posterior knots is then measured (distance “c”) using an arthroscopic hook or distinct arthroscopic measuring devices.

17.The augment is then prepared.

18.Initially, a PDS suture (used as a “shuttle suture”) is tied to one limb of the free suture (previously brought out through the Neviaser port).

19.All 4 anchor suture limbs, as well as the ‘free suture’ limb that is tied to the PDS suture, are then brought out through the lateral cannula.

20.The PDS suture is now untied from the free suture limb outside the lateral port, before being passed through hole “d” of the augment.

21.The PDS suture end outside the lateral port is then tied to the free suture limbs again, and pulled to bring the free suture limb out through the Neviaser port.

22.Similarly, the 2 suture limbs of the anterior knot are passed through the anterior “k” hole and the 2 suture limbs of the posterior knot through the posterior “k” hole of the augment.

23.The patch is then rolled over itself to allow it to be passed inside.

24.After this, the free suture limbs outside the Neviaser port are all pulled, thus pulling the matrix over into the bursa (hence the name “pull-over” technique).

25.At the same time, the rolled matrix is pushed through the lateral port into the subacromial space using an artery clip to aid the “pull-over” maneuver.

26.Once the patch is inside the subacromial space, it is laid open flat using a blunt obturator.

27.Medial stabilization of the augment is then performed by tying the 2 “free suture” limbs with arthroscopic knots via the Neviaser port.

28.Subsequently, 2 lateral row anchors are inserted to achieve lateral stabilization.

ACJ, acromioclavicular joint; LHB, head of the biceps; PDS, polydioxanone.