Arthroscopic Rotator Cable Reconstruction With Dermal Allograft Tuberoplasty Augmentation for an Irreparable Massive Rotator Cuff Tear.

Background: Massive irreparable rotator cuff tears present significant management challenges, particularly with nonarthroplasty options. The combination of rotator cable reconstruction with dermal allograft tuberoplasty represents a technique designed to partially restore biomechanical function while addressing persistent pain through biologic augmentation. Indications: This technique is indicated for patients with massive rotator cuff tears involving multiple tendons with significant retraction where complete repair is not possible, particularly when patients experience persistent pain and functional limitations despite conservative management. Technique Description: The procedure involves 2 primary components performed arthroscopically. First, rotator cable reconstruction is performed using nonabsorbable ultrahigh molecular weight polyethylene suture placed in a running nonlocking fashion along the free edge of the rotator cuff from anterior to posterior, with locking stitches at endpoints. The cable is secured at the anterior and posterior margins of the greater tuberosity with a knotless 4.75-mm biocomposite suture anchor. Second, tuberoplasty is performed using power instrumentation to create a smooth acromiohumeral articulation, followed by dermal allograft augmentation. The dermal allograft patch is secured medially using the knotless suture in the previously placed medial anchors and laterally with 5.5-mm biocomposite anchors. Key technical considerations include using accessory percutaneous portals, rolling the graft for insertion through a cannula, and selecting appropriate anchors based on bone quality. Results: The literature supports favorable outcomes, with cable reconstruction demonstrating reduced retear rates and improved acromiohumeral distance, with tuberoplasty separately demonstrating improved pain relief in the setting of rotator cuff tears. The combined approach seeks to address both biomechanical restoration and pain relief through biologic interpositional grafting. Conclusion: Rotator cable reconstruction with dermal allograft tuberoplasty offers a promising nonarthroplasty treatment option for massive irreparable rotator cuff tears. This technique partially restores suspension bridge function while providing biologic augmentation for pain relief and improved acromiohumeral mechanics. The procedure represents an important addition to the surgical armamentarium for managing complex rotator cuff pathology, although further clinical research is needed to establish clinical outcomes and optimal patient selection criteria. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.