Double double-pulley triple row technique for arthroscopic rotator cuff repair: a technical note

Area of Science:

• Orthopedic Surgery
• Arthroscopic Techniques
• Rotator Cuff Repair

Background:

• Large-to-massive rotator cuff tears present challenges in achieving controlled reduction and secure medial fixation.
• Existing arthroscopic techniques may not adequately address the complexities of these extensive tears.

Purpose of the Study:

• To describe the double double-pulley triple-row (DDPTR) technique for arthroscopic rotator cuff repair.
• To detail the indications, surgical steps, and anchor management for the DDPTR method.

Main Methods:

• The DDPTR technique modifies the double-pulley triple-row (DPTR) concept by incorporating an additional medial anchor.
• This creates two independent double-pulley systems sharing a central medial anchor.
• A middle-row knotless anchor is used for reduction, supplemented by two lateral knotless anchors for a suture-bridge construct.

Main Results:

• This technical note outlines the procedural aspects of the DDPTR technique.
• Specific details on footprint preparation, anchor placement, and pulley suture management are provided.

Conclusions:

• The DDPTR technique is presented as a viable arthroscopic option for large-to-massive rotator cuff tears.
• Further biomechanical and clinical studies are required to validate the advantages of this novel surgical approach.