Arthroscopic Knotless Separate Layer Transosseous Equivalent Repair of Delaminated Rotator Cuff Tears

Abstract

Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair.

Comparison of En Masse Repair versus Separate Double-Layer Repair for Delaminated Rotator Cuff Tears: A Systematic Review and Meta-Analysis

“…Similarly, in the context of delaminated cuff tear repair, it has been revealed that the anatomical reduction of the articular layer, specifically the superior capsule, plays a crucial role in determining clinical outcomes [ 44 ]. Therefore, several SDLR techniques that separately suture the superior capsular layer and the bursal tendon layer have been proposed to address the benefits of anatomically restoring the superior capsular layer and minimizing tension mismatch between the tendon layers [ 9 , 17 , 18 , 45 , 46 , 47 ].…”

Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores

“…Fluoroscopy was used to verify complete removal. The rotator cuff defect was repaired with side‐to‐side suturing when there was no footprint involvement ( n = 37), with the single‐row technique when the defect was located at the footprint and was below 2 cm ( n = 23), or with a double‐row transosseous equivalent technique when the defect was located at the footprint and was larger than 2 cm ( n = 38) [8]. Acromioplasty was performed in patients with single‐ or double‐row rotator cuff repair ( n = 61), and coracoacromial ligament release without acromioplasty was performed in patients with side‐to‐side repairs ( n = 37).…”