The Y‐Loop for Double‐Row Rotator Cuff Repair: An All‐Arthroscopic Technique

Fig 1. Patient position and landmark identification (right shoulder). The patient is placed in the beach-chair position. The bony landmarks are outlined, and the posterior, anterior, lateral, and anterolateral portals are marked.

Fig 2. Intra-articular arthroscopic images of a right shoulder from the posterior viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. A probe from the anterior working portal is used to evaluate the quality of the biceps tendon (A) and subscapularis tendon (SSc) (B). (G, glenoid; HH, humeral head; LHBT, long head of biceps tendon.)

Fig 3. Representative arthroscopic view of a right shoulder in the beach-chair position with a 30° arthroscope. Via the standard lateral portal, a full-thickness tear of the supraspinatus (SS) is observed from the greater tuberosity of the humerus. (HH, humeral head.)

Fig 4. Intra-articular arthroscopic image of a right shoulder from the lateral viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. The first step of the Y-loop technique is presented. The primary triple-loaded suture anchor is set at a 45° angle toward the rotator cuff footprint, immediately adjacent to the articular margin at the tear center. The suture is passed through the tendon from the subacromial side to the articular side with an equidistant strand distribution. The strands are tagged with numbers 1 to 6 sequentially from posterior to anterior. (HH, humeral head; SS, supraspinatus.)

Fig 5. Intra-articular arthroscopic image of a right shoulder from the lateral viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. The second step of the Y-loop technique is presented. The free end of strand 3 is retrieved posterior to strand 2, creating a half-hitch configuration. The free end of strand 3 is dragged through the half-loop to make a lasso loop. This loop is then tensioned anteriorly while straightening strand 2, forming a secure lasso construct. (SS, supraspinatus.)

Fig 6. Intra-articular arthroscopic image of a right shoulder from the lateral viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. The third step of the Y-loop technique is presented. An identical lasso loop is replicated using strand 4 around strand 5. Both lasso loops are positioned at the center of the rotator cuff tear. (SS, supraspinatus.)

Fig 7. Intra-articular arthroscopic image of a right shoulder from the lateral viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. The fourth step of the Y-loop technique is presented. Knot sequencing proceeds as follows: Paired strands 1 and 2, paired strands 5 and 6, and paired strands 3 and 4. The central knot of strands 3 and 4 is secured at the tear apex. (SS, supraspinatus.)

Fig 8. Intra-articular arthroscopic image of a right shoulder from the lateral viewing portal with a 30° arthroscope. The patient is placed in the beach-chair position. The last step of the Y-loop technique is presented. All strands are fixed at the lateral edge of the greater tuberosity opposing the tear with a lateral-row anchor to maximize footprint coverage. (HH, humeral head; SS, supraspinatus.)