Arthroscopic Rotator Cuff Repair: Double Row

Introduction

Rotator cuff tears are common causes of shoulder complaints. Arthroscopic rotator cuff repair is an established treatment modality for rotator cuff tears with successful clinical outcomes. Improved repair techniques have been developed to maintain the integrity between the footprint and the tendon. Arthroscopic double-row and suture bridge repair improves the contact area between tendon and footprint and supports the healing at the repaired rotator cuff insertion.

Procedure

Two rows of anchors are placed in the humeral head. The medial row is located lateral to the articular surface of the humeral head; a second row is placed more laterally. The cuff tendon is then reattached to the footprint using knot-tying (“suture bridge”) or knotless-anchor fixation.

Patient History

• Individuals over 60 years old

• Tendon degeneration

• Acromial shape III Bigliani with subacromial impingement

• Loss of scapular stabilization and muscle imbalance of the rotator cuff and/or the periscapular muscles

• Accident

Patient Examination

• Atrophy of the supraspinatus and/or infraspinatus muscles

• Limitation of range of motion

• Weakness in active movements

• Pain (especially at night) and sleep disturbance

• Pseudoparalysis of the shoulder (<90 degrees of active anterior elevation)

Imaging

• X-ray: detection of decentering of the humeral head, osteoarthritis, bony outlet impingement, decreased subacromial space (<7 mm).

• Magnetic resonance imaging (MRI): detection of tear pattern, tendon retraction, muscle atrophy, fatty muscle infiltration ( Fig. 22.1 ).

  

• Ultrasound: detection of rotator cuff and biceps integrity.

Treatment Options

Surgical Anatomy

• Diagnostic examination:

• Biceps tendon anchor, pulley system, long head of the biceps

• Articular and subacromial surface of the supraspinatus and infraspinatus tendon

• Rotator cable (crescent-shaped thickening of the rotator tendon fibers)

• Humeral head, glenoid, and glenoid labrum

• Glenohumeral ligaments (GHL): superior GHL, medial GHL, inferior GHL

Surgical Indications

• Clinically symptomatic rotator cuff tears

• Acute traumatic rotator cuff tears

Surgical Technique Setup