Arthroscopic Modified Trapezoid-Shaped Double-Row Repair of Medium-Large-Sized Rotator Cuff Tears

The double-pulley double-row technique has shown many advantages in the treatment of rotator cuff tears in clinics. However, multiple factors affect rotator cuff healing and retearing, including tendon-to-bone contact area, repair tension, and gap formation. Hence, many scholars have proposed various suturing methods to promote rotator cuff healing and reduce retearing. We modified the classic double-pulley structure to a trapezoid-shaped structure without any additional anchors or sutures. This method distributes 1 transverse pulley to the middle part of the tear margin to reduce the tendon tear from falling back into its native position, while minimizing tension on the medial structure, avoiding excessive tendon strangulation, and reducing the risk of a type 2 retear. This technique is easy with fewer suture passages than the regular repair of medium-large-sized rotator cuff tears and avoids the formation of "dog-ears."