Name: Knotless Independent Double-Row Repair and Biceps Augmentation for Anterosuperior Rotator Cuff Tears (Video) | JoVE Journal
Uploaded: 2026-01-23T15:00:00.000+00:00
Duration: 5 min 25 s
Description: Learn a cost-efficient knotless double-row repair technique for anterosuperior rotator cuff tears with simultaneous biceps augmentation. This method improves surgical outcomes and reduces recovery time for patients.

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5 minutes

The authors gratefully thank Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, CMRPG5K0092, CMRPG3M2032, CLRPG3D0045, CMRPG5K021, SMRPG3N0011, SMRPG3P0011; Minister of Science and Technology, Taiwan, MOST 111-2628-B-182A-016, NSTC112-2628-B-182A-002.

This protocol was approved by the institution&#39;s Ethics Committee.
1. Patient selection
<ol>
	<li>Set the following inclusion criteria: patients diagnosed with medium to large RCTs according to the Rodeo classification and less than Patte stage 3 tendon retraction12 with at least 6 months of follow-up, acromiohumeral distance (AHD) &#62; 7 mm on the anteroposterior radiograph in neutral rotation, and supraspinatus muscle fatty infiltration (FI) &#60; Goutallier grade 3 (Figure 1).</li>
	<li>Set the following exclusion criteria: subscapularis tear &#62; Lafosse type 3, fractures, infection-related pathologies, partial or complete tear of LHBT, severe glenohumeral joint osteoarthritis, and deformity of the humeral head on preoperative X-ray.</li>
</ol>
2. Surgical procedure
<ol>
	<li>Place the patient in a beach chair position under general anesthesia with an interscalene block. Traction the operative arm in an adjustable traction device.</li>
	<li>Five portals are needed (posterior, anterior, lateral, anterolateral, and anteroinferior portal) (Figure 2). Perform diagnostic arthroscopy through the posterior portal and make a thorough examination of the RCT.</li>
	<li>Identify the supraspinatus and subscapularis tears. Assess and classify the tear of the subscapularis according to the Lafosse classification (Figure 3A).</li>
	<li>Use the motorized shaver to debride the subscapularis, the glenohumeral joint, and the supraspinatus footprint to create a bleeding bone bed for the repair .</li>
	<li>Shift the arthroscope to the lateral subacromial portal. Assess the tear size and configuration according to Patte12 and Burkart1 and tendon reducibility to the footprint after a thorough release of the supraspinatus and subscapularis from all sides.</li>
	<li>Shift the arthroscope back to the posterior portal for the subscapularis repair using a double-loaded suture anchor at the footprint of the subscapularis.</li>
	<li>Perform lasso loop repair13 by parking the 1st suture limb posterior to the SSC and retrieving it anteriorly with a retrograde retriever. Repeat this step on the next two limbs, while making a lasso-loop on the 4th and final suture limb.</li>
	<li>Create a mattress suture (blue sutures) and a lasso-loop (blue-and-white sutures) to secure the subscapularis (Figure 3C,D). Once the loop is secured, pull the free end of the lasso-loop limb to compress the tendon to the footprint and tie it down.</li>
	<li>Compress the mattress suture to the tendon footprint by three half-hitches and four reverse half-hitches. Tie the lasso-loop down with standard three half-hitches and four reverse half-hitches (Figure 3E). The subscapularis repair is completed (Figure 3F).</li>
	<li>Assess the integrity of the long head of the biceps tendon by pulling it into the joint space, allowing visualization along the bicipital groove to reveal any concealed lesions.</li>
	<li>Repair the cuff tear using a triple-loaded suture-based anchor inserted just posterior (5 mm) to the long head of the biceps tendon at the bone cartilage junction. This anchor will also act as the medial row. Lasso-loop one limb of the triple-loaded anchor to re-route the biceps posteriorly to augment the cuff repair anteriorly (Figure 4A).</li>
	<li>Create the lasso loop from one limb (black-white) of the triple-loaded anchor (Figure 4B). Pass the other suture limb (black-white) through the lasso (Figure 4C), providing a rip-stop configuration. Fix the LHBT with seven stitches (Figure 4D).</li>
	<li>Cut the intra-articular part of the LHBT (Figure 4E). Leave a 5 mm LHBT remnant at the supraspinatus footprint&#39;s anterior edge, providing more soft tissue coverage at the anterior rotator cable14 (Figure 4F).</li>
	<li>Shuttle the arthroscope back to the lateral subacromial portal. Repair the cuff by shuttling a free flat-braided suture tape from a 4.75 mm knotless suture anchor and one limb (green) from the previous medial row anchor into the joint through the defect (Figure 5A). Use a retrograde suture retriever to pierce the cuff at the musculotendinous junction in a posterior location via the posterior portal (Figure 5B).</li>
	<li>Do not fully withdraw the green suture limb from the cuff. Instead, pass it through the previously created loop and retrieve it back, forming a secure looped construct15.</li>
	<li>Park a second pair of differently colored suture limbs (green and blue/white) from the medial anchor in the joint. Use a bird beak to retrieve the sutures and pass them through the cuff at a location anterior to the initial suture pair (Figure 5E).</li>
	<li>Shuttle the remaining blue/white suture limb from the medial anchor through the anterior cuff, along with the free end of the flat-braided suture tape (Figure 5F). 
	NOTE: This establishes the anterior suture limb for the lateral row.</li>
	<li>Tension the lasso-loop to compress the cuff toward the footprint. Once the loop is secured, tie it down to fix the construct (Figure 6A).</li>
	<li>Cut one suture limb from the tied-down green and blue/white sutures. Retain the remaining limb for lateral row fixation (Figure 6B,C).</li>
	<li>Confirm that the two mattress sutures from the medial row anchor (green and blue/white) and the flat-braided suture tape together form a reverse mattress suture configuration.</li>
	<li>Shuttle all remaining medial row sutures (green and blue/white) and both ends of the flat-braided suture tape through the anteroinferior portal. Load them into a 4.75 mm knotless suture anchor and mallet it down into the greater tuberosity to complete the lateral row fixation (Figure 6D,E). 
	NOTE: This step finalizes the knotless double-row construct.</li>
	<li>Use the FiberWire suture from the knotless suture anchor to reduce any dog-ear deformity, if compression from the flat-braided suture tape and medial sutures is inadequate (Figure 6F). Review the final repair configuration, illustrated in schematic form (Figure 7A,B). 
	NOTE: This represents the completed SpeedFix-style knotless double-row repair.</li>
</ol>
3. Postoperative protocol
<ol>
	<li>Place the arm in an abduction brace for 6 weeks.</li>
	<li>Initiate a self-directed, home-based rehabilitation program16 on postoperative day one, as prescribed by a sports physician.</li>
	<li>Instruct patients to perform five cycles of five repetitions during exercises, tolerating low to moderate pain. 
	NOTE: Activities must be non-pain provoking.</li>
	<li>Restrict passive physical therapy and instrument-assisted strengthening for the first 3 months.</li>
	<li>Allow formal supervised strengthening and return to sports only after 3 months.</li>
</ol>

<ol><li>Burkhart, S. S., Lo, I. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Arthroscopic+rotator+cuff+repair%5BTitle%5D)+AND+%22J+Am+Acad+Orthop+Surg%22%5BJournal%5D)">Arthroscopic rotator cuff repair.</a> J Am Acad Orthop Surg. 14 (6), 333-346 (2006).</li>
<li>Park, J. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Combined+subscapularis+tears+in+massive+posterosuperior+rotator+cuff+tears%3A+do+they+affect+postoperative+shoulder+function+and+rotator+cuff+integrity%5BTitle%5D)+AND+%22Am+J+Sports+Med%22%5BJournal%5D)">Combined subscapularis tears in massive posterosuperior rotator cuff tears: do they affect postoperative shoulder function and rotator cuff integrity.</a> Am J Sports Med. 44 (1), 183-190 (2016).</li>
<li>Grueninger, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Arthroscopic+repair+of+massive+cuff+tears+with+large+subscapularis+tendon+ruptures+%28Lafosse+III%2FIV%29%3A+a+prospective+magnetic+resonance+imaging-controlled+case+series+of+26+cases+with+a+minimum+follow-up+of+1+year%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">Arthroscopic repair of massive cuff tears with large subscapularis tendon ruptures (Lafosse III/IV): a prospective magnetic resonance imaging-controlled case series of 26 cases with a minimum follow-up of 1 year.</a> Arthroscopy. 31 (11), 2173-2182 (2015).</li>
<li>Park, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Part+I%3A+footprint+contact+characteristics+for+a+transosseous-equivalent+rotator+cuff+repair+technique+compared+with+a+double-row+repair+technique%5BTitle%5D)+AND+%22J+Shoulder+Elbow+Surg%22%5BJournal%5D)">Part I: footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.</a> J Shoulder Elbow Surg. 16 (4), 461-468 (2007).</li>
<li>Park, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Part+II%3A+biomechanical+assessment+for+a+footprint-restoring+transosseous-equivalent+rotator+cuff+repair+technique+compared+with+a+double-row+repair+technique%5BTitle%5D)+AND+%22J+Shoulder+Elbow+Surg%22%5BJournal%5D)">Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.</a> J Shoulder Elbow Surg. 16 (4), 469-476 (2007).</li>
<li>Denard, P. J., Jiwani, A. Z., Lädermann, A., Burkhart, S. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Long-term+outcome+of+arthroscopic+massive+rotator+cuff+repair%3A+the+importance+of+double-row+fixation%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation.</a> Arthroscopy. 28 (7), 909-915 (2012).</li>
<li>Nelson, C. O., Sileo, M. J., Grossman, M. G., Serra-Hsu, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Single-row+modified+Mason-Allen+versus+double-row+arthroscopic+rotator+cuff+repair%3A+a+biomechanical+and+surface+area+comparison%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">Single-row modified Mason-Allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison.</a> Arthroscopy. 24 (8), 941-948 (2008).</li>
<li>Kim, K. C., Shin, H. D., Cha, S. M., Park, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparisons+of+retear+patterns+for+three+arthroscopic+rotator+cuff+repair+methods%5BTitle%5D)+AND+%22Am+J+Sports+Med%22%5BJournal%5D)">Comparisons of retear patterns for three arthroscopic rotator cuff repair methods.</a> Am J Sports Med. 42 (3), 558-565 (2014).</li>
<li>Collin, P., Mccoubrey, G., Ladermann, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Posterosuperior+rotator+cuff+repair+by+an+independent+double-row+technique%3A+technical+note+and+radiological+and+clinical+results%5BTitle%5D)+AND+%22Orthop+Traumatol+Surg+Res%22%5BJournal%5D)">Posterosuperior rotator cuff repair by an independent double-row technique: technical note and radiological and clinical results.</a> Orthop Traumatol Surg Res. 102 (3), 405-408 (2016).</li>
<li>Collin, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prospective+evaluation+of+clinical+and+radiologic+factors+predicting+return+to+activity+within+6+months+after+arthroscopic+rotator+cuff+repair%5BTitle%5D)+AND+%22J+Shoulder+Elbow+Surg%22%5BJournal%5D)">Prospective evaluation of clinical and radiologic factors predicting return to activity within 6 months after arthroscopic rotator cuff repair.</a> J Shoulder Elbow Surg. 24 (3), 439-445 (2015).</li>
<li>Mascarenhas, R., Khair, M., Verma, N. N., Provencher, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Single-row+rotator+cuff+repair%3A+SpeedFix+and+triple-loaded+anchor%5BTitle%5D)+AND+%22Tech+Shoulder+Elbow+Surg%22%5BJournal%5D)">Single-row rotator cuff repair: SpeedFix and triple-loaded anchor.</a> Tech Shoulder Elbow Surg. 18 (4), 121-128 (2017).</li>
<li>Patte, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Classification+of+rotator+cuff+lesions%5BTitle%5D)+AND+%22Clin+Orthop+Relat+Res%22%5BJournal%5D)">Classification of rotator cuff lesions.</a> Clin Orthop Relat Res. 254, 81-86 (1990).</li>
<li>Lafosse, L., Lanz, U., Saintmard, B., Campens, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Arthroscopic+repair+of+subscapularis+tear%3A+surgical+technique+and+results%5BTitle%5D)+AND+%22Orthop+Traumatol+Surg+Res%22%5BJournal%5D)">Arthroscopic repair of subscapularis tear: surgical technique and results.</a> Orthop Traumatol Surg Res. 96 (8), S99-S108 (2010).</li>
<li>Burkhart, S. S., Esch, J. C., Jolson, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+rotator+crescent+and+rotator+cable%3A+an+anatomic+description+of+the+shoulder%27s+suspension+bridge%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">The rotator crescent and rotator cable: an anatomic description of the shoulder's suspension bridge.</a> Arthroscopy. 9 (6), 611-616 (1993).</li>
<li>Lafosse, L., Van Raebroeckx, A., Brzoska, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+new+technique+to+improve+tissue+grip%3A+the+lasso-loop+stitch%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">A new technique to improve tissue grip: the lasso-loop stitch.</a> Arthroscopy. 22 (11), 1246.e1-1246.e3 (2006).</li>
<li>Roulet, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Immediate+self-rehabilitation+after+open+Latarjet+procedures+enables+recovery+of+preoperative+shoulder+mobility+at+3+months%5BTitle%5D)+AND+%22Knee+Surg+Sports+Traumatol+Arthrosc%22%5BJournal%5D)">Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months.</a> Knee Surg Sports Traumatol Arthrosc. 27 (12), 3979-3988 (2019).</li>
<li>Hawkins, R. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Measure+what+matters%3A+single+assessment+numeric+evaluation+score+as+the+critical+measure+for+shoulder+outcomes%5BTitle%5D)+AND+%22J+Shoulder+Elbow+Surg%22%5BJournal%5D)">Measure what matters: single assessment numeric evaluation score as the critical measure for shoulder outcomes.</a> J Shoulder Elbow Surg. 33 (6), 1397-1403 (2024).</li>
<li>Constant, C. R., Murley, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+clinical+method+of+functional+assessment+of+the+shoulder%5BTitle%5D)+AND+%22Clin+Orthop+Relat+Res%22%5BJournal%5D)">A clinical method of functional assessment of the shoulder.</a> Clin Orthop Relat Res. 214, 160-164 (1987).</li>
<li>Michener, L. A., Mcclure, P. W., Sennett, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((American+shoulder+and+elbow+surgeons+standardized+shoulder+assessment+form%2C+patient+self-report+section%3A+reliability%2C+validity%2C+and+responsiveness%5BTitle%5D)+AND+%22J+Shoulder+Elbow+Surg%22%5BJournal%5D)">American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness.</a> J Shoulder Elbow Surg. 11 (6), 587-594 (2002).</li>
<li>Chen, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+suture-bridge+and+independent+double-row+techniques+for+medium+to+massive+posterosuperior+cuff+tears%3A+a+two-year+retrospective+study%5BTitle%5D)+AND+%22BMC+Musculoskelet+Disord%22%5BJournal%5D)">Comparison of suture-bridge and independent double-row techniques for medium to massive posterosuperior cuff tears: a two-year retrospective study.</a> BMC Musculoskelet Disord. 24 (1), 154(2023).</li>
<li>Kim, Y. -S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Arthroscopic+in+situ+superior+capsular+reconstruction+using+the+long+head+of+the+biceps+tendon%5BTitle%5D)+AND+%22Arthrosc+Tech%22%5BJournal%5D)">Arthroscopic in situ superior capsular reconstruction using the long head of the biceps tendon.</a> Arthrosc Tech. 7 (2), e97-e103 (2018).</li>
<li>Boutsiadis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Long+head+of+the+biceps+as+a+suitable+available+local+tissue+autograft+for+superior+capsular+reconstruction%3A+the+Chinese+way%5BTitle%5D)+AND+%22Arthrosc+Tech%22%5BJournal%5D)">Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: the Chinese way.</a> Arthrosc Tech. 6 (5), e1559-e1566 (2017).</li>
<li>Mcclatchy, S. G., Parsell, D. E., Hobgood, E. R., Field, L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Augmentation+of+massive+rotator+cuff+repairs+using+biceps+transposition+without+tenotomy+improves+clinical+and+patient-reported+outcomes%3A+the+biological+superior+capsular+reconstruction+technique%5BTitle%5D)+AND+%22Arthroscopy%22%5BJournal%5D)">Augmentation of massive rotator cuff repairs using biceps transposition without tenotomy improves clinical and patient-reported outcomes: the biological superior capsular reconstruction technique.</a> Arthroscopy. 40 (1), 47-54 (2024).</li>
<li>Cho, N. S., Yi, J. W., Lee, B. G., Rhee, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retear+patterns+after+arthroscopic+rotator+cuff+repair%3A+single-row+versus+suture+bridge+technique%5BTitle%5D)+AND+%22Am+J+Sports+Med%22%5BJournal%5D)">Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique.</a> Am J Sports Med. 38 (4), 664-671 (2010).</li>
</ol>

The authors have no conflicts of interest to declare.

The K-IDR offers a cost-effective alternative to the traditional TOE-SB, like the conventional independent double-row technique using fewer anchors13. Unlike TOE-SB&#39;s four to five anchors, K-IDR uses only two anchors for supraspinatus repair and biceps tenodesis-one at the medial and one at the lateral row, comparable to that of a single-row repair but with the strength of a double-row repair9. The third anchor can be used to repair the subscapularis if needed. The K-ID...

An increasing number of orthopedic surgeons are performing arthroscopic rotator cuff tear (RCT) repair. Advancements in surgical principles, techniques, and instrumentation have enabled arthroscopic repair of rotator cuff tears across all sizes and tear patterns1. RCTs are frequently involved in the anterosuperior part2,3. While there are many techniques to repair the cuff arthroscopically, the double-row repair provides better coverage of the footprint4,5 and a lower retear rate compared to a single-row repair6. Numerous authors have described and modified the double-row repair technique with promising clinical results4,7. 
The transosseous-equivalent suture bridge (TOE-SB) technique using four suture anchors offers a stable repair with predictable re-tear rates8. Colin et al. described the independent double-row repair, which entails the use of only two suture-loaded anchors at the medial and lateral row9, which has a similar retear rate compared with the traditional transosseous-equivalent suture bridge repair10. However, the knots in the independent double-row technique are kept in the subacromial space. 
In our technique, we use one triple-loaded anchor to fix the medial part of the rotator cuff with knots. Further, we shuttle the remaining suture from the medial row, along with cut flat-braided suture tape from the knotless suture anchor, to the greater tuberosity, to complete a SpeedFix technique11 using inverted mattress stitches that directly compress into the prepared bone socket without leaving knots in the subacromial space. The knotless, independent double-row (K-IDR) technique offers a greater area of footprint compression compared to the traditional independent double-row technique.

<table><tbody><tr><td>4.75 mm Swivelock anchor&amp;nbsp;</td><td>Arthrex, Naples, FL</td><td></td><td>(knotless) suture anchor with one FiberTape and one Fiberwire, for rotator cuff repair.</td></tr><tr><td>FiberTape</td><td>Arthrex, Naples, F</td><td></td><td>flat-braided suture tape</td></tr><tr><td>Healicoil&amp;nbsp;Regenesorb</td><td>Smith&amp;nbsp;&amp;amp;&amp;nbsp;Nephew,&amp;nbsp;Andover, MA</td><td></td><td>Double-loaded absorbable suture anchors for rotator cuff repair.</td></tr><tr><td>SPSS software</td><td>IBM, Armonk, NY</td><td></td><td>version 25.0</td></tr><tr><td>Y-Knot RC All-suture anchor</td><td>ConMed&amp;nbsp;Linvatec, Largo, FL</td><td></td><td>Triple-loaded all suture anchors for rotator cuff repair.</td></tr></tbody></table>

knotless independent double-row repair and biceps augmentation for anterosuperior rotator cuff tears

Knotless Independent Double-Row Repair and Biceps Augmentation for Anterosuperior Rotator Cuff Tears

Rotator cuff tears are frequent, mainly involving the anterosuperior shoulder tissue, such as the supraspinatus, subscapularis, and the long head of the biceps tendon (LHBT). The double-row repair was designed to provide better footprint coverage and a lower retear rate than a single-row repair for supraspinatus tears. Traditionally, a double-row repair needs two medial-row suture anchors and two lateral-row suture anchors to provide a wide compression area. However, the medical expenses associated with this technique are quite high. We developed a modified knotless independent double-row repair technique using only two suture anchors. This surgical technique presents a detailed procedure that includes patient positioning and preparation, creation of arthroscopic portals, assessment and confirmation of injuries, and repair of an anterosuperior cuff tear using one suture-loaded anchor for subscapularis repair, another suture-loaded anchor for LHBT tenodesis and medial row repair of supraspinatus, and one lateral row anchor to achieve a knotless, independent double-row repair. It serves as a cost-effective alternative to the traditional transosseous-equivalent suture bridge repair, which uses more anchors.

We retrospectively collected data on patients with medium to large RCTs who underwent a knotless, independent double-row repair from March 2023 to June 2024. Preoperative and postoperative 1 year follow-up radiographs, including AHD, Hamada classification, and ultrasound findings, were recorded. Outcomes were measured using the Subjective Shoulder Value (SSV)17, Constant Score18, and the American Shoulder and Elbow Surgeons (ASES) score19. Follow-up ...

This is a technical note describing a cost-efficient, knotless, independent, double-row rotator cuff repair for medium to large anterosuperior rotator cuff tears with simultaneous biceps augmentation and subscapularis repair.

Rotator cuff tears are frequent, mainly involving the anterosuperior shoulder tissue, such as the supraspinatus, subscapularis, and the long head of the ...

The patient is placed in a beach chair position under general anesthesia. Five portals are needed, posterior, lateral, anterolateral, anterointeferior, and lateral portals. Diagnostic arthroscopy is started from the posterior portal.Identify the supraspinatus and subscapularis tears then classify the subscap tear according to the Lafosse classification. The radio frequency ablator and shaver is used to debride the subscapularis, the glenohumeral joint, and the supraspinatus footprint, to create a healthy bone bed for the repair. Shift the arthroscope to the lateral subacromial portal.Assess the tear size configuration according to Patte and Burkhart, and the tendon reducibility to the footprint after the release of the supraspinatus and subscapularis. Shift the arthroscope back to the posterior portal for the subscapularis repair using a double loaded suture anchor at the footprint of the subscap. A lasso-loop repair is done by parking the first suture limb posterior to the subscapularis and retrieving it anteriorly with a retrograde retriever.This step is repeated on the next two limbs while making a lasso loop on the fourth and final suture limb. Once secured, pull the free end of the lasso limb to compress the tendon to the footprint and tie it down. The remaining limbs are tied in the same way.The subscapularis repair is completed. The cuff is repaired using a triple-loaded suture anchor inserted just posterior to the long head of the biceps tendon at the bone cartilage junction. Lasso loop one limb of the triple-loaded anchor to reroute the biceps posteriorly to augment the anterior cuff.Pass the other suture limb through the lasso to provide a rip-stop construct, and tie the biceps down. Pierce the cuff at the musculotendinous junction from the posterior portal, using a retrograde retriever, after shuttling a free suture tape and one limb from the previous medial row anchor into the joint defect. Do not fully withdraw the green suture limb from the cuff, and instead pass it through the previously created loop and retrieve it back to form a loop construct.Park a second pair of different colored suture limbs from the medial anchor into the joint. Use a retrograde suture retriever, and pass them through the cuff at a location anterior to the first pair of sutures. Shuttle the remaining suture limb from the medial row anchor with the free end of the flat-braided suture tape through the anterior cuff.Tension the lasso loop to compress the cuff towards the footprint. Tie it down to fix the construct. The other suture limb from the medial row anchor is also tied down.Cut only one suture limb from the tied down sutures for the lateral row fixation. Shuttle all remaining medial row sutures and both ends of the suture tape through the anteroinferior portal. Load them into a 4.75 millimeter knotless suture anchor and mallet it down towards the greater tuberosity to complete the lateral row fixation.The fiberwire suture from the knotless suture anchor can be used to reduce any dog-ear deformity of the cuff. This completes the speed-fix style knotless double-row repair.

knotless-independent-double-row-repair-biceps-augmentation-for

Research

JoVE Journal

Medicine

We propose a technical modification for capsular reconstruction that utilizes arthroscopic rerouting and fixation of the long head of the biceps tendon to enhance the repair of massive irreparable rotator cuff tears.

Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears

Massive irreparable rotator cuff tears (MIRCTs) pose significant clinical challenges due to their complex pathology and limited treatment options. This study introduces whole rotator cable reconstruction (WRCR) using proximal biceps tendon autograft as a novel surgical technique for MIRCTs.

Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft

This protocol presents an optimized rotator cuff repair technique that combines the medial knot-tying suture-bridge repair with a rip-stop configuration, designed to enhance cuff healing and minimize the risk of retear.

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

We describe two tactile sensory testing methods for acute or chronic periods of spinal cord injury in rats.  These validated procedures can detect the development and maintenance of allodynia-like sensations.

Acute and Chronic Tactile Sensory Testing after Spinal Cord Injury in Rats

The constricting cuff presented in this article is designed to induce atherosclerosis in the murine common carotid artery. Due to the conical shape of its inner lumen the implanted cuff generates well-defined regions of low, high and oscillatory shear stress triggering the development of atherosclerotic lesions of different inflammatory phenotypes.

Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice

The murine cervical heart transplantation model is well suited for immunological as well as ischemia reperfusion injury studies. We modified the procedure using a non-suture cuff technique and performed more than 1,000 successful transplants with this approach. Herein, we provide additional details of this technique to supplement the video.

Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

Quantitative measurement of bone progenitor function in fracture healing requires high resolution serial imaging technology. Here, protocols are provided for using intravital microscopy and osteo-lineage tracking to sequentially image and quantify the migration, proliferation and differentiation of endogenous osteogenic stem/progenitor cells in the process of repairing bone fracture.

Sequential In vivo Imaging of Osteogenic Stem/Progenitor Cells During Fracture Repair

During mammalian development, early gestational skin wounds heal without a scar. Here we detail a reliable and reproducible model of fetal scarless wound healing in the cutaneous dorsum of E16.5 (scarless) and E18.5 (scarring) mouse embryos.

A Mouse Fetal Skin Model of Scarless Wound Repair

Flexor tendons in the hand are commonly injured, leading to impaired hand function. However, the scar-tissue healing response is not well characterized. A murine model of flexor tendon healing is demonstrated here. This model can enhance overall understanding of the healing process and assess therapeutic approaches to improve healing.

Murine Flexor Tendon Injury and Repair Surgery

Learn a cost-efficient knotless double-row repair technique for anterosuperior rotator cuff tears with simultaneous biceps augmentation. This method improves surgical outcomes and reduces recovery time for patients.

Knotless Independent Double-Row Repair and Biceps Augmentation for Anterosuperior Rotator Cuff Tears

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