Autologous Palmaris Longus Tendon Augmentation for Large to Massive Rotator Cuff Tears

This technical note describes an arthroscopic technique that utilizes the autologous palmaris longus (PL) tendon to augment large to massive rotator cuff tears when complete repair is not feasible. The PL tendon is harvested through a minimal wrist incision and delivered intramuscularly into the supraspinatus and/or infraspinatus using a shuttle relay technique. Subsequently, standard double-row fixation is performed, incorporating the PL in a crossed suture bridge configuration. This method offers a biologically favorable and mechanically supportive alternative to dermal allografts, with minimal donor-site morbidity. This technique may enhance graft integrity and healing potential and could be adapted using alternative tendons when PL is absent. Further studies are warranted to assess the long-term clinical outcomes.