Table 2.
Steps of Hybrid Rotator Cuff Repair (Modified SpeedBridge and Double-Pulley Technique)
| 1. Perform a thorough subacromial bursal debridement. |
| 2. Assess cuff mobility in a medial-to-lateral direction. |
| 3. Measure the anteroposterior distance of the rotator cuff tear. |
| 4. Place 2 fully loaded (FiberTape and No. 2 FiberWire) 4.75-mm Bio-Composite SwiveLock anchors in the anteromedial and posteromedial rows, adjacent to the articular margin. |
| 5. From anterior to posterior, place the FiberWire-FiberTape-FiberWire in an inverted-mattress fashion using a self-retrieving passer. Do this for the anterior and posterior limbs of the tear. When passing stitches, bring the tape and suture out through the anterior portal to manage the anterolateral-row fixation. Bring the tape and suture from the posterior limb out through the posterior viewing portal to manage posterolateral-row fixation. |
| 6. Place a FiberLink cinch loop if there is cuff tendon flaring (dog-ears) present at the anterior and posterior edges of the rotator cuff tear (optional step). |
| 7. Perform lateral-row modified SpeedBridge fixation. |
| A. Anterolateral-row fixation with anterior FiberLink (optional): Secure 1 FiberTape from the anteromedial anchor and 1 FiberTape from the posteromedial anchor into the anterolateral margin of the greater tuberosity with a 4.75-mm SwiveLock anchor. |
| B. Posterolateral-row fixation with posterior FiberLink (optional): Secure 1 FiberTape from the posteromedial anchor and 1 FiberTape from the anteromedial anchor into the posterolateral margin of the greater tuberosity using a 4.75-mm SwiveLock anchor. |
| 8. Perform the double-pulley technique. |
| A. Bring 1 FiberWire from the anteromedial and posteromedial anchors through the mid-lateral portal. Slide the sutures back and forth to check for any entrapment of the suture underneath the FiberTape used during the SpeedBridge fixation. |
| B. Tie an extracorporeal knot over the post of the knot pusher with 6 throws of a surgeon's knot. Cut excess FiberWire on top of the knot. |
| C. Bring the remaining 2 free sutures out together from the anterior portal. |
| D. Toggle the 2 free sutures back and forth to slide the extracorporeal knot down onto the medial cuff. |
| E. Tie a static knot with the free suture. |