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To medialize the footprint of the rotator cuff and insert suture anchors for medial row fixation, we removed 3-4 mm of medial articular cartilage from the junction of the articular cartilage and the medial aspect of the footprint on the greater tuberosity using a ring curette and a burr. The footprint on the greater tuberosity Tryptophan synthase was also debrided. A 6.0-mm Duet suture anchor (Linvatec, Largo, FL, USA) was inserted 3-4 mm medially of the junction of the articular cartilage and the medial aspect of the footprint on the greater tuberosity. Sutures were passed through approximately 7-10 mm of the medial portion of the torn tendons in a mattress manner and then tied with a sliding knot. Depending on the tear size and pattern, two or three suture anchors were used for medial row fixation (Fig. 1A). Fig. 1 Schematic illustrations of the mini-open suture bridge technique with porcine dermal patch augmentation. (A) Medialization of the footprint and medial row fixation using suture anchors. (B) Suture bridge fixation and marginal sutures with porcine dermal ... To reinforce the repaired rotator cuff, a Permacol patch was created of an appropriate size and configuration. Medial suture limbs then were passed selleck inhibitor again through the patch and tied with two half-hitch knots. Tied suture limbs from the medial row were fixed at 1.5 cm distal to the lateral edge of the footprint using Footprint suture anchors (Smith & Nephew, London, UK). Additionally, 5-8 marginal sutures using No. 2 non-absorbable sutures (Ethicon, Cornelia, GA, USA) were placed at the medial, anterior, and posterior borders I BET151 of the grafted patch (Fig. 1B). Wearing an abduction brace, patients were immobilized until 6 weeks after surgery, and then they started passive range of motion exercises. They began active range of motion exercises at 10 weeks after surgery. Muscle-strengthening exercises were allowed at 4 months and sports and occupational activities at 6 months after surgery. Clinical and Radiological Assessments Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California, Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was evaluated by MRI at 6 months postoperatively. The diagnosis of a fullthickness retear was made when a fluid-equivalent signal or discontinuity of the rotator cuff was found in one or more of the standard T2-weighted images (3 mm intervals).3) Graft incorporation was defined as intermediate signal intensity around the graft with intact continuity on oblique coronal T2-weighted images.3) Statistical analyses of preoperative and postoperative outcome measures were performed using the Wilcoxon signed-rank test. Statistical significance was set at a p-value of
