Arthroscopic Extreme Medialized Repair for Massive Rotator Cuff Tear: Resection of Cartilage and Subchondral Bone Over the Top of the Humeral Head

Rotator cuff repair is a widely performed surgery. Its purpose is to improve shoulder function, fix tendons to bones, restore anatomical structure, and prevent the progression of rotator cuff tear arthropathy and associated muscle degeneration. However, in large and massive tears, the tension imposed during repair becomes too high. Medialized repairs have been reported for cases of rotator cuff tear, but they are difficult to perform. We report on ex-medialization that used common portals and instruments to remove the osteochondral and subchondral bone, reduce humeral head volume, and suture the tendon extremely medially. Compared to a common medialized repair, this procedure reduces tension on the rotator cuff to be sutured. The goal of this technique is to restore functional anatomy, reduce the rate of retear, prevent the progression of rotator cuff muscle atrophy and fatty degeneration, and to improve muscle strength by allowing the repair of rotator cuff tears (Goutallier grade 2 or higher) to the humeral head, which have conventionally been challenging.