Rotator cuff repair techniques: Current concepts

Abstract

Arthroscopic rotator cuff repair is being performed by an ever-increasing number of surgeons. With an ageing population and growing patient expectations it is crucial that clinical outcomes are optimised. Anatomical reduction of the tendon back to its footprint with minimal tension contributes to this, but this can only be achieved if key biomechanical factors are taken into consideration. In this review of the technical aspects of a rotator cuff repair, we focus on: (1) patient positioning, (2) biomechanical principles, (3) optimal visualisation, and (4) repair techniques for both anterior and postero-superior tears.

Keywords: Rotator cuff injuries; Rotator cuff repair; Shoulder arthroscopy; Shoulder pain.

Fig. 1

Schematic of factors that can be modified in order to control intra-operative bleeding.

Fig. 2

Types of ‘locked’ suture used in arthroscopic rotator cuff repair (A–C) Rip stop: A load-sharing construct characterised by an inverted horizontal mattress suture (i.e. the ‘rip stop’) secured to a lateral row anchor, combined with a simple suture from a medial row anchor that is placed medial to the horizontal limb. (D–F) Mac stitch/The Massive cuff stitch: Free horizontal suture loop combined with a simple suture from an anchor. Both sutures are independently tied.

Fig. 3

Superior view of a crescent-shaped rotator cuff tear involving supraspinatus and infraspinatus. A: mobility is medial to lateral. B and C: Suture bridge repair is one technique that may be applied to this type of tear. The medial row of pre-loaded anchors is placed and sutures passed. The lateral row is made by crossing sutures and using a knotless anchor.

Fig. 4

Superior view of a U-shaped rotator cuff tear involving supraspinatus and infraspinatus. A: Mobility is more anterior and posterior to the middle than medial to lateral. This can be closed through margin convergence sutures. B: Side-to-side sutures (margin convergence) create a free margin, which can then be reduced to the bone in a medial to lateral direction. C: In this example, a single row repair technique has been used to finish the repair.

Fig. 5

Superior view of an L-shaped rotator cuff tear involving supraspinatus and infraspinatus. A: The mobility is posteromedial to anterolateral. A traction suture at the anterior corner aids reduction. B and C: In this double-row technique, the medial row of sutures is passed to advance the free edge of the tendon to a reduced position, aided by the traction suture. Once tied, one suture tail from each anchor is placed in a knotless anchor laterally.