SpeedBridge Knotless Double‐Pulley Rotator Cuff Repair

Fig 1. Viewing from our lateral portal and inserting the rotary shaver or burr from our posterior portal, the rotator cuff footprint is prepared for medial row anchor placement. The articular border and location for medial row anchor placement is also identified, which are placed at typical location for appropriate reduction of rotator cuff tendon.

Fig 2. Viewing from our posterior portal. An 18-gauge spinal needle is inserted through our established lateral portal or in a percutaneous approach and is used to identify the desired trajectory for posteromedial and anteromedial anchor placement.

Fig 3. Viewing from our posterior portal. An anteromedial row anchor is placed at the typical location for appropriate reduction of rotator cuff tendon.

Fig 4. Viewing from the lateral portal. The knotless anchor is placed at the posteromedial row through the percutaneous portal. The anteromedial row anchor can also be seen.

Fig 5. Viewing from the posterior portal. The posteromedial preloaded spliced tape is retrieved from the posteromedial knotless anchor and passed through the rotator cuff in appropriate location for standard repair.

Fig 6. Viewing from our posterior portal. Having passed with a self-retrieving suture passer preloaded with a FiberLink suture adjacent to the more posterior FiberTape sutures, the tail end of the FiberLink suture is retrieved from an accessory superior portal.

Fig 7. Viewing from our posterior portal. From the lateral portal, the knotless SwiveLock sutures are retrieved and loaded into the FiberLink loop. Then, the tail end of the FiberLink that was previously retrieved through the superior portal is pulled to shuttle the sutures from the knotless SwiveLock through the rotator cuff.

Fig 8. (A) Viewing from the posterior portal. The preloaded, spliced tape is retrieved from the anteromedial anchor through the lateral portal. (B) The tape is passed through the rotator cuff in desired fashion. Following this step, in similar fashion as the posteromedial anchor, a FiberLink suture is loaded on the self-retrieving suture passer, the tail of the FiberLink is then passed and retrieved from the accessory superior portal. From the lateral portal, the knotless SwiveLock sutures are retrieved and loaded into the FiberLink loop.

Fig 9. (A) Viewing from the posterior portal. The anterior anchor blue repair suture is retrieved. (B) Simultaneously, the posterior anchor loop portion of the shuttle suture is obtained through lateral portal. Outside the shoulder, the blue repair stitch is loaded through the loop portion of the shuttle suture, folding the blue repair stitch at the ink-mark indicator. The tail end of the posterior anchor passing suture is then pulled to load the knotless mechanism.

Fig 10. (A) Viewing from the posterior portal. The posterior anchor repair suture, colored black and white, is retrieved. (B) Simultaneously, the loop portion of the anterior anchor shuttle suture is obtained through the lateral portal. Outside the shoulder, the black and white repair stitch is loaded through the loop portion of shuttle suture.

Fig 11. Viewing from the lateral portal. Once the tail end of the anterior anchor passing suture is pulled to load the anterior anchor knotless mechanism, the two repair sutures are tensioned to the desired amount.

Fig 12. Viewing from the lateral portal. The lateral row repair is completed in standard fashion of a double-row technique by retrieving the FiberTape suture from each medial row anchor and loading each lateral row anchor. Each limb is independently tensioned to remove any slack of tendon. Once the lateral row has been placed, the knotless suture anchors are further tensioned to the desired tension and cut flush. The completed knotless double-pulley rotator cuff repair can be seen here.