Large Footprint Bone Cyst: Arthroscopic Autologous Cylinder Press-Fit with Buddy Anchor Interference-Fit for Rotator Cuff Repairt

BACKGROUND: About 20–25% of all rotator cuff tears are associated with footprint bone cysts. Large cysts (>10 mm2) are rare but can be problematic for anchor fixation and rotator cuff repair. So far treatment of footprint bone cysts was described using large or several anchors, cement, or compaction grafting mostly with allograft bone being biologically inferior to restore bone stock compared to autologous grafts. METHODS/RESULTS: We report about a 57-year-old manual laborer with persistent pain and loss of shoulder function (subjective shoulder value [SSV] 50%). Magnetic resonance imaging showed a high-grade partial supraspinatus tendon tear (>50%) associated with a large supraspinatus footprint bone cyst (10 mm × 11 mm × 17 mm). An efficient setup in lateral position for arthroscopic autologous press-fit grafting from the iliac crest is described for single-stage arthroscopic rotator cuff repair. Improved fixation was achieved using a buddy anchor interference-fit technique. CONCLUSION: The clinical follow-up after 12 months showed an excellent outcome (SSV >90%, DASH-Score 14 points, and Constant-Score 87 points) with dynamic ultrasound and radiographs confirming tendon and bone stock restoration.