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Chronic distal biceps tendon ruptures present a unique surgical challenge due to tendon retraction and shortening as well as muscle atrophy. Several graft choices and fixation methods have been described, with no one technique proving superior to date. We describe a technique wherein a tibialis anterior tendon allograft is Pulver-Taft weaved through the muscle belly to achieve incorporation with the muscle and tendonous fascia to achieve superior pull-out strength., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

We present the technique of biologic tuberoplasty, where an acellular dermal allograft is used to cover the tuberosity in patients with massive irreparable cuff tears to prevent bone-to-bone contact between the tuberosity and acromion when active elevation is attempted. This technique can be performed in patients with massive rotator cuff tears who are low-demand and have significant medical comorbidities, poor bone quality, or who are not candidates for a reverse shoulder arthroplasty or who cannot tolerate a lengthy rehabilitation protocol. It is less time-consuming than a superior capsule reconstruction and more bone-sparing than traditional tuberoplasty. Patients with massive rotator cuff tears involving the supraspinatus and a portion of the infraspinatus lose their force couple, leading to superior humeral head migration with abutment of the tuberosity against the acromion upon deltoid activation. The center of rotation moves superiorly with deltoid contraction, developing an acromiohumeral articulation. This results in bone-to-bone contact between the acromion and humerus, leading to pain and acetabularization of the acromion over time. Coverage of the tuberosity with the acellular dermal allograft acts as an interpositional tissue and prevents bone-to-bone contact between the tuberosity and acromion., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Superior capsule reconstruction has gained popularity as a treatment option for massive rotator cuff tears. The initial graft described was a tensor fascia lata. In the United States, acellular dermal matrix or dermal allograft has gained popularity. The results from published reports have been promising, but graft tear on postoperative imaging has been reported in several studies. Strives are being made to reduce the graft tear rate. One such way is to increase the thickness of the graft. Biomechanical studies have shown that thicker and stiffer grafts perform better in restoring superior stability. We present a technique of doubling a commercially available 3 mm dermal allograft and making it into a 6 mm graft for superior capsule reconstruction., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Ulnar collateral ligament reconstruction of the elbow has evolved substantially since its introduction in 1974. Numerous variations of the surgery have been introduced, including modifications in tunnel creation, graft tensioning, and fixation. These changes have aimed to improve overall quality of the reconstruction; however, even the most commonly used techniques still present many challenges. We describe a technique for ulnar collateral ligament (UCL) reconstruction using bisuspensory button fixation and a single tunnel on both the ulnar and humeral sides. This technique avoids many of the most common complications and methods of failure of UCL reconstruction, provides immediate strong graft fixation, and offers the surgeon a technically less demanding procedure., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Glenoid chondral injuries constitute challenging injuries to treat because of the limited access and the limited options and evidence available for their resolution. The purpose of this Technical Note is to describe the procedure, pearls, and pitfalls of implantation of a cryopreserved osteochondral allograft (Cartiform) for the treatment of full-thickness cartilage defects of the shoulder. Cartiform is a cryopreserved osteochondral allograft composed of chondrocytes, chondrogenic growth factors, and extracellular matrix proteins that can be implanted through a single-stage procedure.

BioCartilage (BC) is dehydrated, minced human hyaline articular cartilage that was developed as an adjunct to microfracture surgery to help stimulate the bone marrow and stem cells to form hyaline-like tissue in full-thickness chondral defects. The minced pieces of BC require a dry environment for application and can easily be disrupted by residual moisture of saline solution in the surrounding tissues. We present a technique of carbon dioxide insufflation during knee arthroscopy as a means of maintaining a dry environment for preparation of the bony bed during BC augmentation of microfracture surgery. This technique is safe and provides more than adequate visualization, as well as a dry environment, to make the arthroscopic application of BC significantly more efficient.