A Novel Arthroscopic Medial Knot-Tying Suture-Bridge Repair with Rip-Stop Technique for Rotator Cuff Tears

Rotator cuff tears are common and arthroscopic suture-bridge repair with medial knot tying is widely used due to its superior biomechanical properties and higher healing rates. However, type two retears often caused by suture cutout at the medial site remain a challenge and incorporating a rip-stop configuration in the repair, may improve tendon healing and reduce retear risk. In this video, we'll introduce our arthroscopic medial knot tying suture-bridge repair with rip-stop technique for rotator cuff tears.

Informed consent was obtained from the patient for publication and this study was approved by the institutional review board in our hospital. Our surgical protocol contains the following steps After general analgesia and brachial plexus block, place the patient in the lateral decubitus position. Identify and mark the arthroscopic portals required.

Treat the patient in a sterile fashion and apply a six kilogram weight to track the affected shoulder. Perform a comprehensive examination of all intraarticular structures. Perform a biceps tenotomy or tenodesis, and repair the subscapular at this stage if necessary.

Perform subacromial bursectomy and acromioplasty. Debride the tear margin to identify the tear pattern. Use the suture retriever to temporarily reduce the torn cuff tendon.

Prepare the bone bed. Insert two double-loaded suture anchors at the articular margin of the greater tuberosity. Place the first anchor in the interimedial aspect of the greater tuberosity near the biceps groove through the anterior portal.

Place the second anchor, 1.5 centimeter posterior to the first anchor, through the posterolateral portal. Using a suture hook pass one purple suture limb and one striped suture limb from the first anchor simultaneously through the anterior part of the supraspinatus, about two to three millimeter lateral to the musculotendinous junction. Sequentially pass the other ends of the purple and stripe sutures from the first anchor, from anterior to posterior through the torn supraspinatus tendon at points posterior to the previous penetration side.

Ensure that the suture limbs spread evenly across the anterior half of the torn cuff tendon. Pass the suture limbs from the second anchor through the supraspinatus in a manner similar to the suture limbs from the first anchor. Ensure that the suture limbs spread evenly across the posterior half of the torn tendon.

Pull the two ends of the striped suture from the first anchor, from the anterolateral portal and secure them with a sliding knot, positioning the knot at the penetration point of the posterior stripe suture limb from the first anchor. Pull the two ends of the purple suture from the second anchor, tied them with a sliding knot and place the knot at the penetration point of the anterior purple suture limb from the second anchor. So thread two purple suture limbs and one striped suture limb from the first medial anchor along with one purple suture limb from the second medial anchor through the added of the knotless anchor.

Ensure proper tensioning of the future strands and advance the knotless anchor into the prepared hole. Repeat the previous step to place a second knotless anchor. Arthroscopic evaluation of rotator cuff repair integrity.

At one year after surgery, the patient demonstrated significant pain relief, complete restoration of shoulder function, and full range of motion. Postoperative one year MRI confirmed complete healing of the cuff tendon. In conclusion, we believe our medial knot-tying suture-bridge repair with rip-stop configuration can both improve the healing environment and reduce retear risk, offering a better choice for rotator cuff tears.