Surgical Technique of Arthroscopic Transosseous Implant‐Less Rotator Cuff Repair Using “Arthrocuff” System

Fig 1. External image (right shoulder), of a patient in left lateral position, demonstrating the. low lateral portal (4 cm from the tip of the acromion) for introduction of the Arthrocuff transosseous guide.

Fig 2. (A) External image (right shoulder), of a patient in left lateral position arm suspended in traction with a 4-kg weight. (B) Diagnostic arthroscopy performed through the posterolateral portal. (C) Arthroscopic view from posterior portal demonstrating full-thickness crescentric cuff tear. A, anterior; L, lateral; M, medial; P, posterior; S, supraspinatus tear. (D) External image (right shoulder), in left lateral position seen from posterior, demonstrating the lateral portal made for pilot awl. (E) Demonstration of the pilot hole in a cadaveric bone. (F) Arthroscopic view from posterior portal showing the entry awl in the medial rotator cuff foot print on the humeral head. A, anterior; H, humeral head foot print; L, lateral; M, medial; P, posterior.

Fig 3. Arthroscopic view into the right shoulder, from posterior portal, showing the transosseous tunnel and shuttling sutures. The tunnel also acts like a crimson-duvet, bathing the repair surface with the much-needed biology. A, anterior; H, humeral head foot print; L, lateral; M, medial; P, posterior; S, supraspinatus tear; T, vertical limb of the tunnel with shuttle sutures.

Fig 4. (A) External image of the right shoulder from the front, demonstrating the entry of Arthrocuff jig via the accesory lateral portal. Note: The tip of the jig is inserted first. (B) Once the tip is viewed subacromialy, the jig is maneuvered to engage the pilot hole. (C) The jig snugly fits once engaged in the pilot hole.

Fig 5. (A) Arthrocuff instrumentation. (B) Picture demonstrating the dimensions of the bone bridge. (C) The pilot hole is made close to the articular surface, and the jig has an inbuilt 10-mm horizontal offset and 22-mm vertical offset that helps in maintaining adequate bone bridge. (D) The pilot hole and the transverse drill meet to complete the tunnel.

Fig 6. (A) External image of the right shoulder from front, demonstarting the Arthrocuff jig in the accesory lateral portal, and through the cannulated handle in the jig, a 2.9-mm drill with a stopper is used to create the transverse tunnel. (B) Locking screw tip guide: The arrow showing the locking screw docked in the tip of the guide. (C) The guide is introduced through the cannulated handle, and the screw locks onto the tip of the Arthrocuff jig. (D) Arthroscopic view of the right shoulder from posterior portal showing the lateral cortex of the proximal humerus, the Arthrocuff jig (J) and the guide, which is introduced through the cannulated handle and into the lateral cortex of humerus (G). M, medial, L, lateral, H, lateral cortex of humerus. (E) Arthroscopic view of the right shoulder from posterior portal showing the lateral cortex of the proximal humerus (H), the Arthrocuff jig (J) and the shuttle sutures (S) after the screw is locked on the jig and the guide is withdrawn. L, lateral; M, medial. (F) External image of the right shoulder from the front, demonstrating the Arthrocuff jig in the accesory lateral portal, and through the cannulated handle in the jig, the guide is…

Fig 7. (A) Picture demonstrating the Arthrocuff jig in the pilot hole in a cadaveric bone (left humerus). (B) The lateral cortex of the humerus is drilled through the cannulated handle of the Arthrocuff jig. (C) Close in view demonstrating how the locking screw with shuttle sutures engages with the Arthrocuff jig. (D) The shuttling process can be seen completed in the image once the Arthrocuff jig is withdrawn from the pilot hole.

Fig 8. (A) Arthroscopic view of the right shoulder from posterior portal with arrow showing the tip of Arthrocuff jig (J) with the screw and shuttle sutures locked onto the tip (S), humeral head footprint (H). Ant, anterior; L, lateral; M, medial; P, posterior. (B) Arthroscopic view of the right shoulder from posterior portal showing the shuttle sutures. (D) The shuttle sutures are used to pass FiberWires across the tunnel. (E and F) Using a Multifire Scorpion (Arthrex) and sliding knots (arrow), cuff repair is completed.

Fig 9. (A) Arthroscopic view of the right shoulder from posterior portal, after. supraspinatus repair using the Arthrocuff system, showing a wide area of compression compared to the point contact with suture anchors. A, anterior; C, cuff; H, lateral cortex of humerus; L, lateral; M, medial; P, posterior. (B) The knots are placed over the lateral cortex, rather than on the cuff tissue.