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. 2020 Sep 18;10(3):e19.00021. doi: 10.2106/JBJS.ST.19.00021

Arthroscopic Knotless-Anchor Rotator Cuff Repair

Florian Freislederer ^1,^a, Markus Scheibel ¹

PMCID: PMC8154396 PMID: 34055468

Abstract

The most common type of rotator cuff lesion is a tear of the supraspinatus tendon, with arthroscopic rotator cuff repair representing an established treatment option^1-3. Several double-row techniques have been described to achieve complete coverage of the rotator cuff footprint. Among these is the bridging, double-row, transosseous-equivalent rotator cuff repair, which has become one of the most popular techniques for its maximized contact area and initial fixation strength^4-9. However, medial cuff failure is a common complication following this procedure^9-14.

To reduce medial strangulation and overall surgical time, all-knotless anchor repair has been introduced as an alternative technique¹⁵.

The arthroscopic knotless, bridging, double-row, transosseous-equivalent technique is performed with the patient in the beach-chair position via lateral operative and viewing portals. A medial row of suture anchors is placed in the usual fashion. The tendon is then perforated twice per anchor with use of a suture-passer device, after which the suture limbs are bridged over the tendon and fixed in a lateral row of anchors.

Excellent functional outcomes as well as satisfaction in >90% of patients have been reported with the supraspinatus knotted double-row, bridging, transosseous-equivalent repair^{4,9,11,13,16-19}. No significant differences have been reported for clinical results and tendon integrity on magnetic resonance imaging when comparing knot-tying and knotless double-row transosseous-equivalent rotator cuff repair; however, the rate of medial cuff failure was lower among knotless procedures^{1,12,16,17,20-25}.

The major steps of the procedure, which are demonstrated in this video article, include (1) diagnostic arthroscopy; (2) supraspinatus tear visualization and debridement; (3) decortication of the footprint on the greater tuberosity; (4) placement of the medial row of anchors loaded with nonabsorbable suture tape; (5) separate suture passage of each limb, perforating the tendon with use of a suture passer; (6) fixation of the tape in the lateral row of anchors, creating a bridging configuration; and (7) anterolateral acromioplasty with use of an arthroscopic burr.

Complications are rare following this procedure. As postoperative rehabilitation is essential for tendon healing, the operative arm should be placed in an abduction brace for 6 weeks, with only passive mobilization.

Download video file^{(16.9MB, mp4)}

DOI: 10.2106/JBJS.ST.19.00021.vid1

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DOI: 10.2106/JBJS.ST.19.00021.vid2

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DOI: 10.2106/JBJS.ST.19.00021.vid3

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DOI: 10.2106/JBJS.ST.19.00021.vid4

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DOI: 10.2106/JBJS.ST.19.00021.vid5

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DOI: 10.2106/JBJS.ST.19.00021.vid6

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DOI: 10.2106/JBJS.ST.19.00021.vid7

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DOI: 10.2106/JBJS.ST.19.00021.vid8

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DOI: 10.2106/JBJS.ST.19.00021.vid9

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DOI: 10.2106/JBJS.ST.19.00021.vid10

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DOI: 10.2106/JBJS.ST.19.00021.vid11

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DOI: 10.2106/JBJS.ST.19.00021.vid12

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DOI: 10.2106/JBJS.ST.19.00021.vid13

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DOI: 10.2106/JBJS.ST.19.00021.vid14

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DOI: 10.2106/JBJS.ST.19.00021.vid15

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DOI: 10.2106/JBJS.ST.19.00021.vid16

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Published outcomes of this procedure can be found at: Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2628-34.

Investigation performed at Schulthess Klinik, Zurich, Switzerland

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSEST/A306).

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