"Triple Package" Modified SpeedBridge Rotator Cuff Repair Technique

Abstract

Treatment of full-thickness rotator cuff repairs vary in surgical technique depending on many factors including tear geometry, delamination of soft tissue, tissue quality, and rotator cuff retraction. The described technique presents a reproducible method of addressing tear patterns where the tear may be larger laterally, but the medial footprint exposure is small. This can be addressed with a single medial anchor combined with a knotless lateral-row technique to provide compression for small tears or two medial row anchors for moderate to large tears. In this modification of the standard knotless double row (SpeedBridge) technique, 2 medial row anchors are used, with 1 augmented with additional fiber tape and an additional lateral row anchor to create a triangular repair construct, increasing the size and stability of the footprint of the lateral row.

Fig 1

Open view, right shoulder, viewing from above the shoulder with the patient in the beach chair position. The 5 standard portal locations are identified with corresponding cannulas in the posterolateral, lateral, and anterior lateral portals.

Fig 2

Arthroscopic view of a right shoulder with the 30° arthroscope in the posterolateral viewing portal. The supraspinatus tendon is demonstrated with a crescent tear with significant associated delamination. Note that the space at the medial footprint for medial row anchor placement is small.

Fig 3

Arthroscopic view of a left shoulder with the 30° arthroscope in the lateral portal. Some delaminated tissue has been debrided, demonstrating the narrow crescent pattern with minimal exposed medial footprint but significant retraction in the central portion of the tear.

Fig 4

Arthroscopic view of a left shoulder with the 30° arthroscope in the posterior lateral portal. A suture anchor with a single blue tape has already been placed anteriorly and is not visualized. The posterior suture anchor is being placed with 2 broad sutures tapes in the posterior position on the medial footprint. One suture tape is colored purple with a surgical pen to assist with suture management.

Fig 5

Arthroscopic view of a left shoulder with the 30° arthroscope in the lateral portal. A suture-passing device is seen entering from the anterior portal. A suture grasper is used first to reduce the delaminated layers of the rotator cuff (left image) and then to retrieve the suture passing wire from the suture passage device (right image) from the posterior lateral portal.

Fig 6

Arthroscopic view of a left shoulder with the 30° arthroscope in the posterior lateral portal. The suture from the knotless mechanism in the anteriormost medial anchor has been passed anterior to the broad suture tapes and is being secured to restore the anteriormost aspect of the rotator cable, as well as to prevent dog-ear formation. This step is repeated for the posterior knotless anchor (not shown).

Fig 7

Arthroscopic view of a left shoulder with the 30° arthroscope in the posterior lateral portal. One suture tape from the central portion of the rotator cuff (purple) and one from the anterior portion that have been previously passed through the rotator cuff tissue medially are loaded into a lateral suture anchor and are seen being inserted in the anteriormost position of the lateral row. The process is then repeated with the other anterior tape and a posterior tape for the central lateral row anchor and the central and posterior rotator cuff to the most posterior lateral row anchor (not shown).

Fig 8

Arthroscopic view of a left shoulder with the 30° arthroscope in the lateral portal demonstrates the final construct, including medial suture row passage sites through the rotator cuff tissue and lateral row anchors.