Table 2.

Pearls and Pitfalls of Strings

Pearls

Arm both sides of the Strings with sutures “on the table” before introducing them into the joint.

Pass the medial sutures of the Strings approximately 20 mm medial to the lateral edge of the tear to create an extensive overlap of both tendons and increase the contact area.

Introduce and fix single Strings one-at-a-time or as maximum in pairs to maintain good visibility and sufficient space during arthroscopy.

Place the suture anchors far enough laterally on the greater tuberosity in order to create slight tension on the Strings and the remaining rotator cuff.

Pitfalls

Debride the stump of the remaining rotator cuff extensively to identify viable tendon tissue of adequate quality to form the medial attachment of the Strings.

Be aware to test tendon excursion before determining the length of the Strings as tensioning of the Strings significantly lateralizes the remaining tendon which reduces the required String-length.

If using multiple strings avoid the placement of too many suture anchors on the lateral aspect of the greater tuberosity by inserting the Strings in pairs.