Thank you very much, and thanks to the program committee for allowing us to present our work. Our disclosures are available in the course book and at AOS.org. We all know that rotator cuff healing remains a significant challenge with retail rates even in young, healthy populations ranging between 25 and 75 percent. This has generated a ton of interest in terms of allograft, autograft, and even xenograft choices, therefore gaining popularity to augment healing. Recently our group had described the use of an autograft biceps graft taken from tendon normally discarded for tenodesis and tried to turn that into a graft. There are several biologic advantages to using autograft in this setting. First is that autograft tenocytes initiate mesenchymal stromal cell differentiation into tenocyte-like cells. Also tenocytes support proliferation, migration, and tenogenic differentiation of tendon-derived stem cells and recruit localized stem cells to the site where we most need them. There are also several logistical benefits of using an autograft for patch use. The first is it's readily available. Usually we're throwing these away in the setting of rotator cuff repair or total shoulder arthroplasty when we can be using them to augment the repairs of tendons that we care about. Secondly, and perhaps most importantly, these are free. So we don't have to compete with the cost of many of the processing and storage options that are out there. You can use a free cost of stuff that's already there and in the body. Finally, it's autograft. So you get the cell you're trying to get the other stuff to turn into. The original description that we used was through a commercial skin graft mesher. And unfortunately, while it did expand the area, we did find that the variable patch had a little tough time with structural integrity. In addition to this, we did see that tenosyte viability was reduced down as low as 44%. More recently, a biceps graft compression technique has been developed to create a reproducible, easy to prepare, and insert biceps graft. But it's unknown whether or not this method of compression compromises tenosyte viability. Therefore, the purpose of this study was to determine whether or not compressing the graft led to tenosyte damage in the setting of this procedure. We had a consecutive series of patients undergoing biceps tenodesis. Generally 40 millimeters is normally available for a superpec tenodesis. 27 of this is used for the graft. 13 millimeters of the remnant is then used as shown by the red lines here. What we did is we split that remnant in a longitudinal graft so that we could get tendon samples from the same region of the tendon. This divided it regionally, identically, for biceps samples as represented by the red and green boxes here. One remnant sample was placed into the autograft compression device and compressed into a patch. The second was not compressed, and then both samples were sent to pathology where we asked them to evaluate for tenosyte viability. And discussion with our pathologist confirmed that gross examination under H&E staining would be appropriate to assess for acute tenosyte morbidity and mortality. In terms of results, we had 55 consecutive patients which led to 110 different samples. Seven cases had evidence of necrosis in both the compressed and non-compressed groups, so no difference. Forty-two of the 55 cases demonstrated no evidence of tenosyte damage in either group, so no difference. We did have six cases that did demonstrate a difference between the groups. Four of them showed more damage in the compressed group, and two of them showed more damage in the non-compressed group, and this difference was not statistically significant. The main finding of this study, therefore, was that compression of an autograft biceps into a graft does not result in microscopic damage to the tendon, and 93% of the samples, when you compress them, demonstrate normal tenosyte histology, and that there was no statistical significant difference between compressed and non-compressed samples for tenosyte viability. We do have some limitations with this study. First, they were from the same region of the tendon, but medial and lateral may represent a difference between the two. And secondly, we did not do advanced tenosyte metabolic activity analysis in this. It's possible that compression led to gross histology that was normal, but yet maybe that the function of those tenosytes may be compromised. Nevertheless, in conclusion, biceps autograft appears to be a locally available, cost-effective option for rotator cuff augmentation, and that compression of the autograft can result in reproducible and robust graft sources for insertion that does not compromise tenosyte viability. Further study is, of course, warranted to determine if this augmentation technique results in improved healing rates and, of course, patient-reported outcomes. Thank you very much for your attention.

autograft biceps grafts

rotator cuff augmentation

cell differentiation

stem cell recruitment

tendon cell viability