Biologic Footprint Reconstruction: Rotator Cuff Repair Using Biologic Tuberoplasty

Irreparable rotator cuff tears present significant challenges owing to tear size, tendon retraction, and poor tissue quality. This article describes a surgical approach integrating biologic tuberoplasty with rotator cuff repair, using an acellular human dermal allograft to re-establish the rotator cuff footprint and prevent bone-on-bone contact between the humeral head and acromion. Footprint reconstruction is defined as allograft coverage of the tuberosity combined with partial cuff repair that includes some contact of the native cuff over the allograft. Changing the nomenclature to "biologic footprint reconstruction" more accurately describes the procedure when combined with partial cuff repair in continuity with the allograft and avoids confusion with isolated biologic tuberoplasty. The graft alleviates pain and creates a biologic healing environment. This approach is designed to reduce surgical complexity and improve efficiency, ensuring reproducibility while restoring shoulder biomechanics and function.