Modified Mason‐Allen Suture Bridge with Double‐Locking Loop Technique for Rotator Cuff Repair

Fig. 1. Surgical positioning and portal placement for arthroscopic RTC repair in a 45-year-old female with a right RTC tear. The patient is positioned in lateral decubitus with pelvic stabilization. The operative arm is secured in a foam traction sleeve with 3-kg longitudinal traction applied via standard traction apparatus. The torso is reclined 30° posteriorly, positioning the arm at 70° abduction and 20° flexion. Bony landmarks are subsequently marked. Portal configuration: standard anterior portal (A), accessory anterolateral portal (B), accessory posterolateral portal (C), standard posterior portal (D), anchor implantation portal (E), and anatomical landmarks in the acromion (F), distal clavicle (G), coronoid process (H), and coracoacromial ligament (I).

Fig. 2. Arthroscopic visualization of a bursal-sided partial-thickness RTC tear in a 45-year-old female. View from the accessory posterolateral portal demonstrates supraspinatus detachment at the greater tuberosity footprint.

Fig. 3. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. Drilling is performed on the footprint site in a 45° direction with the humerus head, and a 2.5-mm all-suture anchor (JoinFix Plus, Rejoin, Hangzhou, China) is then inserted at the medial row.

Fig. 4. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. First step of the mMA stitch with the double-locking technique. Passage of a PDS shuttle suture through the RTC tendon at the medial edge of the tear, directed from the articular to the subacromial side using a suture hook. The midportion of 1 white suture limb is retrieved to the bursal side via a second PDS shuttle, forming a loop. A red arrow indicates the free end of the limb.

Fig. 5. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. Second step of the mMA stitch with double-locking technique. The free end (indicated by red arrow) of the same white suture limb is passed through the RTC tendon ∼10 mm anterior to the initial site. Concurrently, a second white limb is retrieved to the bursal side via a PDS shuttle suture at a point 10 mm posterior to the first position. These 3 points—initial medial anchor point, anterior, and posterior limb passages—form an isosceles triangular configuration.

Fig. 6. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. Third step of the mMA stitch with double-locking technique. Free ends of both white suture limbs (indicated by red arrow) are being pulled through the previously formed bursal-side loop. Tensioning of the limbs establishes dual-locking loops, securing the construct without a traditional knot.

Fig. 7. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. Fourth step of mMA stitch with double-locking technique. Passage of 2 green suture limbs through the RTC tendon at anterior and posterior positions, ∼10 mm medial to the initial fixation site. The free end of one limb is indicated by a red arrow.

Fig. 8. Arthroscopic view of the right shoulder in the lateral decubitus position from the accessory posterolateral portal. Last step of the mMA stitch with double-locking technique. Two sutures with 4 limbs are fixed by a knotless suture anchor, which is implanted into the greater tuberosity lateral row.