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. 2007 Dec 18:8:123.
doi: 10.1186/1471-2474-8-123.

The Roman Bridge: a "double pulley - suture bridges" technique for rotator cuff repair

Francesco Franceschi  1 , Umile Giuseppe Longo, Laura Ruzzini, Giacomo Rizzello, Nicola Maffulli, Vincenzo Denaro
Affiliations

The Roman Bridge: a "double pulley - suture bridges" technique for rotator cuff repair

Francesco Franceschi et al. BMC Musculoskelet Disord. .

Abstract

Background: With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing.

Methods: We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure.

Results: Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint.

Conclusion: This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone.

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Figures

Figure 1
Figure 1
Two medial row suture Bio-Corkscrew anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint, just lateral to the articular surface of the humeral.
Figure 2
Figure 2
Two suture limbs from each anchor are sequentially passed through two single points in the rotator cuff.
Figure 3
Figure 3
Two suture limbs from each anchor are sequentially passed through two single points in the rotator cuff.
Figure 4
Figure 4
A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod.
Figure 5
Figure 5
The two free suture limbs are pulled to transport the knot over the top of the tendon bridge.
Figure 6
Figure 6
The two free suture limbs are tied with a Surgeon's Sixth Finger (Arthrex, Naples, FL) knot pusher as a static, nonsliding knot.
Figure 7
Figure 7
The two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL).
Figure 8
Figure 8
The final results.
Figure 9
Figure 9
A schematic drawing of the Roman Bridge technique.
See this image and copyright information in PMC

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