Shoulder Rotator Cuff Tear: Double-Row Suture Technique for Stronger Repair

Hello. I'm Dr. Dongkyu Lee, an orthopedic specialist. Today, let me introduce a case where I used the double-row suture technique for a stronger repair during arthroscopic rotator cuff surgery. When a rotator cuff tear has progressed significantly, simple suture repair alone may not withstand the tension on the rotator cuff, leading to re-tears. Additionally, if the tear has been present for a long time, advanced degenerative changes in the tendon can also cause re-tears. The double-row suture technique involves suturing the rotator cuff in two layers. The area where the rotator cuff attaches to the humerus is called the "foot print," and this technique secures it not just two-dimensionally but three-dimensionally as a surface. This case involves a 67-year-old female patient. She had suffered from pain for a long time and had only received injection treatments. Recently, injections no longer helped, daily activities became difficult, and night pain prevented sleeping, prompting her to visit our clinic. Physical examination showed positive impingement sign and empty can test.

MRI shows the torn rotator cuff (supraspinatus) outlined by the red dotted line within the blue circle. It has completely detached from the foot print of the humerus and retracted approximately 1.5cm.

This MRI view shows the shoulder from the side. The yellow arrows indicate the torn rotator cuff, with a tear size of approximately 2cm.

This appeared to be a medium-sized tear, and arthroscopic rotator cuff repair was performed.

The biceps tendon shows signs of tearing. A healthy biceps long head should appear smooth and shiny on arthroscopy, but here it appears tattered and frayed.

After biceps tenotomy and debridement of frayed tissue.

The area outlined by the purple dotted line is the torn rotator cuff (supraspinatus). Fortunately, the degree of degenerative change in the tendon is not severe.

Two suture anchors are being inserted medially into the foot print of the humerus. After passing sutures through the torn rotator cuff, two lateral knotless anchors secure the cuff to create a surface repair across the foot print.

The torn rotator cuff has been firmly secured using the double-row suture technique.

Let's compare the post-operative MRI.

The previously torn rotator cuff is now precisely positioned in its original anatomical location.

The previously empty white space now shows the rotator cuff well-attached in its correct position after repair.

The advantages of the double-row suture technique: 1. A larger area of the torn rotator cuff can be attached to the humerus across a wider surface. 2. The stronger fixation better withstands tension on the rotator cuff. 3. Because the repair is more secure, rehabilitation can begin earlier and more comfortably. Despite being 67, the patient is now doing excellent rehabilitation, sleeping well at night, and functioning normally. Personally, I use the double-row suture technique in nearly all rotator cuff repair surgeries. The reasons are the secure fixation and the ability to begin early rehabilitation.