Rotator Cuff Allograft Reconstruction

Rotator cuff disease is a common disorder and can result in significant pain and dysfunction in the shoulder (See “Rotator Cuff Disease”). The rotator cuff is a blending of 4 tendons together, which envelop or ‘cuff’ the ball of the shoulder joint and assist in stabilizing and rotating the shoulder.  When rotator cuff disease has progressed over an extended period of time or a previous repair has failed to heal, the defect in the rotator cuff can be quite large.  Pain and weakness may become disabling and unresponsive to conservative treatment measures.  In most instances, even very large to massive tears involving complete disruption of 2 or 3 tendons can still be repaired using tiny incisions, a lighted viewing lens (arthroscope) and small instruments.   When there is inadequate rotator cuff tissue remaining for repair, alternatives must be considered, but are limited.  In patients 60 or fewer years in age that have unmanageable symptoms, a reconstruction of the rotator cuff can provide reasonable improvement.  A sheet of cadaver skin (allograft) is harvested in a sterile manner.  Once the your rotator cuff is debrided and the size of the remaining defect measured, the allograft is shaped to fit.  Multiple sutures are passed through the graft outside of the shoulder.  The graft and sutures are then delivered into your shoulder through a small tube (cannula) and the sutures are passed through the margins of the remaining intact cuff.  One edge of the graft is then repaired to bone using small suture anchors.  The graft spans the defect in the rotator cuff.  The rehabilitation is progressed slowly to enable the graft to have adequate time to incorporate with your own cuff tissue.  Gradual restoration of motion occurs during the first 3 months, after which time, progressive strengthening is initiated.  Full recovery may require 9 – 12 months.   Complete graft incorporation occurs in approximately 75% of patients.