Augmentation of Arthroscopic Rotator Cuff Repair Using Enthesis Interpositional Allograft and Minced Autologous Subacromial Bursa.

Multiple strategies for rotator cuff augmentation have been developed to promote tendon healing and decrease retear rates. Previously published techniques and clinical studies have primarily emphasized biologic adjuncts intended to alter the local healing environment at the repair site or structural reinforcement with grafts. Although autologous subacromial bursal tissue has a potential benefit through local delivery of mesenchymal stem cells, it is difficult to maintain at the repair site. In vitro studies of scaffold augmentation with a demineralized interpositional graft are promising and would allow for the addition of biologic adjuncts directly at the repair site. Each strategy for augmentation offers distinct advantages and disadvantages, and the complimentary mechanisms of graft and biologic augmentation allow them to be combined. This technical note describes an augmentation technique for arthroscopic rotator cuff repair that incorporates an interpositional biphasic allograft in conjunction with autologous subacromial bursal tissue. The described technique provides a scaffold for healing at the enthesis while simultaneously delivering autologous tissue to promote tendon-to-bone healing. A combined strategy may represent a practical approach to optimizing repair integrity in patients at increased risk of failure after rotator cuff repair.