Dr. Garcia demonstrates his cutting edge technique for arthroscopic patch augmentation for revision rotator cuff repairs.

In this video, Dr. Grant Garcia walks through a complex arthroscopic revision rotator cuff repair (RCR) augmented with a dermal allograft patch. This procedure is designed for patients who have suffered a failure of a previous rotator cuff repair, leaving them with compromised, diseased tendon tissue and leftover surgical hardware.

The surgical progression requires meticulous suture management and structured technical stages:

• Debridement & Bed Preparation: The procedure begins by extensively clearing out loose debris, diseased tendon edges, and old suture threads from the previous failure. Dr. Garcia uses a specialized power pick to microfracture the bone across the greater tuberosity footprint. This carefully exposes marrow cells to stimulate a rich, local vascular healing response without disrupting the absolute medial margin.
• Medial Row Anchor Placement: Two 4.75 mm bio-composite SwiveLock anchors—pre-loaded with heavy FiberTape and FiberWire stay sutures—are placed in the medial row (one anterior, one posterior), leaving deliberate spacing between them.
• Trans-Tendon Suture Passage: To optimize vascularity and structural compression over the already compromised tissue, a knotless suture pattern is utilized. Using specialized retrievers, the stay sutures are passed through the cuff tendon in a horizontal mattress pattern, while the swedged FiberTapes are interleaved sequentially between them. All limbs are managed and pulled out through the back to prevent any inside-joint tangling.
• Graft Measurement and Preparation: Dr. Garcia switches out the working portal for a wide 12 mm Passport cannula to prepare for patch insertion. Using a Superior Capsular Reconstruction (SCR) measurement guide, he captures the precise medial-to-lateral and anterior-to-posterior dimensions of the tissue void. A 2 mm thick dermal allograft patch is mapped out, oriented with directional arrows, and pre-drilled. The FiberTapes are threaded roughly 5 mm from the graft's edge, and the four remaining FiberWire stay limbs are positioned slightly more medially.
• The Double-Pulley Shuttling Method: To slide the allograft patch smoothly into the tight subacromial space, a double-pulley technique is engineered by tying the corresponding medial FiberWires together outside the joint. Pulling the opposite limbs acts as a mechanical hoist, drawing the graft directly down through the Passport cannula. Dr. Garcia uses an arthroscopic Kingfisher tool to manipulate, flatten, and unfold the patch over the native tendon footprint.
• Lateral Double-Row Fixation: Once the graft is centered, individual FiberTapes are retrieved through their respective anterior and posterior portals. Bone punches are made at the lateral footprint to complete a standard SpeedBridge layout. The FiberTapes cross over the top of the allograft patch, compressing both the patch and the underlying native cuff tendon tightly into the bone as they are locked down with two lateral SwiveLock anchors.
• Medial Cinching & Final Inspection: Finally, attention is redirected back to the medial row. The double-pulley sutures are tied down arthroscopically using alternating half-hitches to ensure uniform, flat compression across the entire graft-tendon interface.

The repair concludes with an interactive internal and external rotation stability check. Probing confirms that the dermal patch is securely compacted down to the bone with less than 3 to 4 mm of edge mobility, successfully creating a reinforced, uniform construct out of the previously failed repair.