Arthroscopic Biologic Acromiotuberoplasty for Irreparable Rotator Cuff Tears

Editorial Commentary: Bursal Acromial Resurfacing Offers Improved Biomechanics in Laboratory Studies but There Is No Consensus on Indications, Technique, or Graft Type, and Clinical Results Are Lacking

Bursal acromial reconstruction/resurfacing, acromiograft, and biologic tuberoplasty are all terms used to describe the concept of fixing a graft (human dermal allograft or fascia lata) to the undersurface of the acromion or onto the greater tuberosity with the aim of achieving pain relief and improved function in patients with massive irreparable cuff tears. The rationale for these procedures is based on the biomechanical concept that an interpositional spacer can reverse superior migration of the humeral head, increase acromiohumeral distance, reduce subacromial contact pressure, and limit painful bone-on-bone contact. These types of procedures are postulated to offer potential advantages (cost savings related to use of implants, long-term biologic solution, technical ease of surgery, and short surgical time) over other options for massive irreparable cuff tears, particularly superior capsule reconstruction and in some respects the subacromial balloon. However, these advantages remain unproven because published clinical studies are sparse. Furthermore, there is no current consensus on indications, technique, or optimum graft choice.