Arthroscopic Lamina-Specific Double-Row Fixation for Large Delaminated Rotator Cuff Tears

Abstract

Delamination is a commonly observed finding at the time of rotator cuff repair, but few studies have described the surgical techniques used for delaminated rotator cuff tears (RCTs) or their clinical outcomes. We developed a technique using a combination of a double row and an additional row, which we call lamina-specific double-row fixation, for large delaminated RCTs. The lamina-specific double-row technique is performed using an additional row (lamina-specific lateral row) of suture anchors placed between the typical medial and lateral rows of suture anchors. The technique is performed as follows: (1) medial-row sutures are passed through the inferior (articular-side) and superior (bursal-side) layers in a mattress fashion; (2) lamina-specific lateral-row simple sutures are passed through the inferior layer; and (3) lateral-row simple sutures are passed through the superior layer. We believe that this technique offers the following advantages: (1) creation of a larger area of contact between the inferior layer and the footprint, (2) higher initial fixation strength of the articular-side components of the repaired rotator cuff tendon, and (3) an adaptation between the superficial and inferior layers. This technique represents an alternative option in the operative treatment of large delaminated RCTs.

Location and thickness of delaminated rotator cuff tears: cross-sectional analysis with surgery record review

“…Based on previous reports regarding the clinical results of repairs of delaminated rotator cuff tears, the clinical results of the series in which each layer was separately repaired have been better compared with those in which both layers were repaired together as a single layer 10, 16, 22, 23. In other reports, rotator cuff tears with delamination are often described as having a high rate of postoperative tear, which occurs at the articular side 19 .…”

The “Parachute” Technique: A Simple and Effective Single-Row Procedure to Achieve an Increased Contact Area Between the Cuff-Tendon and Its Footprint

“…Delamination is a commonly observed finding at the time of rotator cuff repair, 9 , 10 and clinical studies have reported it as a negative prognostic factor in rotator cuff healing. 11 The repair of delaminated tears is more complex than that of nondelaminated tears, mainly because the margin of the inferior (articular-side) layer is usually more retracted than that of the superior (bursal-side) layer.…”

Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients

“…The operative technique of ALSDR has been described in detail previously (Figure 1). 22 The operative indication of ALSDR was as follows: The treating surgeon evaluated delamination by pulling the torn superior and inferior layers laterally to the footprint using a tendon grasper with a 7-mm bite. If the edge of the inferior layer could be grasped and pulled laterally to the footprint with the grasper, we regarded this inferior layer as thick and tough tissue.…”

“…11,13,25,35 Therefore, we developed a technique using a combination of a double row and an additional row, which we call arthroscopic lamina-specific double-row fixation (ALSDR), for the treatment of large-sized delaminated RCTs in active patients. 22…”