Triple-Row Modification of the Suture-Bridge Technique for Arthroscopic Rotator Cuff Repair

Abstract

Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suturebridge techniques in an effort to reconstruct the rotator cuff footprint and improve fixation. However, when using this technique for larger tears, it can be difficult to get the lateral portion of the rotator cuff into an anatomic position. This report describes a triple-row modification of the suture-bridge technique that results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. Maximizing the rotator cuff footprint contact area exposes more of the tendon to bone and may improve the healing potential.

Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

“…This generates compression at the anchor sites only, which strangulates the tendon medially and may lead to medial cuff failure. 25,26 The modified star-shaped, triple-row technique proposed in this study has many theoretical advantages compared with the double-row and the suture-bridge techniques. The double-row technique restores the footprint anatomically but without an efficient contact pressure.…”

“…This triple-row technique, with the central middle anchor tied first, allows tensionfree knotting of the medial row with better footprint coverage as well as higher contact pressure. The possibility of tendon mobilization with the grasper to its native footprint was described as a tension-free repair by Ostrander et al 25,26 In the present study, a modification of the originally described triple-row technique is proposed, in which the middle repositioning central anchor sutures are linked to the lateral knotless anchors to produce more tension-free repair and more tendon compression. As well, from a biomechanical point of view, the more interconnection that exists between anchors, the less likely a tension mismatch during humeral rotation will occur.…”

Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears

“…Consequently, a medial row sutures tied over an anatomically reduced tendon without over tension is the main goal. This could be achieved through adequate release of the retracted tendon in addition to adding a repositioning or a reducing anchor before even tying the medial row sutures (triple-row concept) 12 , 13 …”

“…Replicating the normal footprint anatomy can maximize the contact area and contact pressure as well as ultimate load to failure without deleterious impact on the biology. 13 The main advantage of the triple-row technique is a tension-free knotting of the medial anchors. The potential for tension-free repair was confirmed by tendon mobilization with the grasper to the lateral border of the native footprint.…”

“…A triple-row modification of SB technique was proposed by Ostrander et al. 12 , 13 in which an additional middle row was inserted independent of medial and lateral rows. It has been demonstrated that this technique results in significantly more footprint contact area and contact pressure compared with the DR and transosseous-equivalent techniques.…”