Knotless Independent Double-Row Repair and Biceps Augmentation for Anterosuperior Rotator Cuff Tears

Rotator cuff tears are frequent, mainly involving the anterosuperior shoulder tissue, such as the supraspinatus, subscapularis, and the long head of the biceps tendon (LHBT). The double-row repair was designed to provide better footprint coverage and a lower retear rate than a single-row repair for supraspinatus tears. Traditionally, a double-row repair needs two medial-row suture anchors and two lateral-row suture anchors to provide a wide compression area. However, the medical expenses associated with this technique are quite high. We developed a modified knotless independent double-row repair technique using only two suture anchors. This surgical technique presents a detailed procedure that includes patient positioning and preparation, creation of arthroscopic portals, assessment and confirmation of injuries, and repair of an anterosuperior cuff tear using one suture-loaded anchor for subscapularis repair, another suture-loaded anchor for LHBT tenodesis and medial row repair of supraspinatus, and one lateral row anchor to achieve a knotless, independent double-row repair. It serves as a cost-effective alternative to the traditional transosseous-equivalent suture bridge repair, which uses more anchors.