"The box" allograft augmentation for at risk rotator cuff repairs

Rotator cuff tears are a challenging problem for orthopedic surgeons, especially those with at risk features. Because of this it is imperative to establish reliable methods to maximize patient outcomes and mitigate the risk of retears. Biologic augmentation with dermal allograft augmentation (DAA) has been proposed to improve tendon healing and structural integrity. This study describes a novel arthroscopic technique using DAA augmentation with a box-configuration transosseous-equivalent canopy construct and reports early clinical outcomes.

A retrospective review was performed on patients who underwent arthroscopic rotator cuff repair (RCR) with DAA augmentation using a box-configuration construct between January 2021 and October 2025 by 2 surgeons at a single institution. Pre-operative magnetic resonance imaging was evaluated to classify tear size, tissue quality, and tendon retraction. Clinical outcomes assessed included post-operative pain, range of motion, retear rate, and complications.

Eleven patients underwent RCR with DAA augmentation. Mean age was 59.5 years (range, 51-72) with a mean body mass index of 27.6. Seven repairs (63.6%) were revision procedures. Ten tears (90.9%) were full thickness, with a median of 2 tendons involved and a median Patte retraction grade of 2. Mean follow-up was 7.2 months. Post-operatively, ROM remained excellent in 5 patients (45.5%) and improved in 6 patients (54.5%). Pain improved completely in 9 patients (81.8%) and partially in 2 (18.2%). No post-operative infections were observed or reoperations.

Arthroscopic RCR with DAA augmentation using a box-configuration canopy construct demonstrated favorable early clinical outcomes and a low complication rate in a cohort with a high proportion of revision repairs. Larger prospective studies with longer follow-up are needed to further evaluate the durability and clinical benefits of this technique.