A novel all-arthroscopic technique for biomaterials insertion and positioning on shoulder rotator cuff: Preliminary insights and experience on a cohort of 34 patients.

Purpose: Rotator cuff repair is associated with a high risk of re-tear, especially for large or chronic lesions. Although biological augmentation using grafts has been proposed for improving tendon healing, graft insertion and positioning remain technically challenging and frequently necessitate specialised equipment or graft-specific techniques. This study describes a simple, reproducible and fully arthroscopic surgical technique for positioning and fixing different types of biomaterial graft on the rotator cuff, independently of graft type and prior anchor placement. Methods: A case series of 34 patients is presented. They are operated with a novel fully arthroscopic technique for preparing, inserting, positioning and fixing a decellularized human dermal graft on the rotator cuff. The procedure uses only arthroscopic portals and cannulas without dedicated instrumentation. The graft is prepared with colour-coded sutures and tapes to indicate orientation, passed through the repaired cuff using non-resorbable sutures and positioned under direct arthroscopic visualisation. Medial fixation is achieved through trans-tendinous sutures, while lateral fixation is performed using knotless anchors placed on the greater tuberosity. Clinical evaluation is performed with Constant-Murley and Patient Acceptable Symptomatic State (PASS) scores preoperative and at 6 months of follow-up. Results: The described technique enables precise positioning of the graft over the repaired rotator cuff. Graft orientation, tensioning and greater tuberosity coverage can be adjusted independently of previous anchor placement. The method is compatible with different biomaterials and enables graft insertion without torsion, excessive tension or the need for mini-open approaches or graft-specific devices. No major or minor complication, and no graft dislocation has been reported at 6 months of follow-up. Postoperative Constant-Murley and PASS scores have significantly been improved from baseline. Conclusions: The novel, all-arthroscopic technique provides a safe, versatile and reproducible method for augmenting the rotator cuff with biomaterial grafts, reporting good preliminary early-term clinical results. Level of Evidence: Level IV, case series with no comparison group.