Rotator Cuff Repair Techniques : Wheeless' Textbook of Orthopaedics

- Discussion:
        - rotator cuff repair (menu)
        - mobilization of rotator cuff
        - convergence repair
        - restoration of footprint
        - knot tying techniques

- Considerations for Arthroscopic Repair:
        - required steps: there are several steps for arthroscopic cuff repair and each step needs to be optimally performed w/o interfering w/ other steps;
               - passage of sutures for optimal tendon grasp
               - bone anchor insertion
             - tensioning of sutures (rather than using knots)
               - locking of sutures to anchor (rather than locking of the sutures against bone)

- Suture Bone Tunnel Repair: (Open Repair)

- Bone Anchor Technique:
       - modified convergence technique:
               - bone anchors are inserted at anterior aspect of supraspinatus foot print;
       - direction of insertion:
               - insertion of anchors at a 45 deg angle to the bone surface is recommended;
               - references:
                       - Early pullout of lateral row knotless anchor in rotator cuff repair
                       - Proper insertion angle is essential to prevent intra-articular protrusion of a knotless suture anchor in shoulder rotator cuff repair

- Tendon Suture Passage Considerations:
            - core sutures for hand flexor tendon lacerations
            - Charlotte Shoulder System
            - Rip Stop Repair Techniques:
                    - A load-sharing rip-stop fixation construct for arthroscopic rotator cuff repair.

- Bone Anchor Options:
      - suture knots need to be kept lateral to the greater tuberosity so as to avoid impingement under the acromion;
      - SpeedScrew (lateral row)
      - JuggerKnot (medial row)
      - Mitek Healix Anchor
             - HEALIX TM BR Anchor with ORTHOCORD Suture Anchor In-Vitro Performance
             - HEALIX TM BR & HEALIXTM PEEK Anchor with ORTHOCORD Suture Abrasion White Paper

- References

Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears.

A biomechanical evaluation of suture anchors in repair of the rotator cuff.

The strength of surgical repairs of the rotator cuff. A biomechanical study on cadavers.

The mechanical effects of suture anchor insertion angle for rotator cuff repair.

Rotator Cuff Repair. A Biomechanical Comparison of Three Techniques.

Primary fixation strength of rotator cuff repair techniques: a comparative study.

Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques.

Tendon-to-Bone Pressure Distributions at a Repaired Rotator Cuff Footprint Using Transosseous Suture and Suture Anchor Fixation Techniques.

Cyclic loading of anchor-based rotator cuff repairs: confirmation of the tension overload phenomenon and comparison of suture anchor fixation with transosseous fixation.

Biomechanical Evaluation of Arthroscopic Rotator Cuff Repairs: Double-Row Compared with Single-Row Fixation.

Arthroscopic Double-Row and “Transosseous-Equivalent” Rotator Cuff Repair

Humeral Insertion of the Supraspinatus and Infraspinatus. New Anatomical Findings Regarding the Footprint of the Rotator Cuff

Vascularity of the supraspinatus tendon three months after repair: Characterization using contrast-enhanced ultrasound.