Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair

Fig 1. Coronal illustration, with the patient in the lateral decubitus position, showing the right proximal humerus and supraspinatus tendon, demonstrating the transosseous-equivalent suture bridge repair. It demonstrates the de-tensioning of the rotator cuff repair if the lateral row anchor toggles in the soft bone of the greater tuberosity, weakening the whole repair construct.

Fig 2. Illustration of a tent, demonstrating the guy rope principle. A central pole is held securely in place by 2 guy ropes that oppose the pull of the opposite side of the tent and make a stable and strong construct.

Fig. 3. (A) Illustration, with the patient in the lateral decubitus position, of the lateral view of the conventional transosseous equivalent rotator cuff repair, demonstrating the 2 FiberTape sutures, which come from each medial row anchor and are secured into the bone of the greater tuberosity via the lateral row anchors. This secures the supraspinatus tendon down over its anatomic footprint. (B) Coronal illustration of the right shoulder showing the proximal humerus and supraspinatus tendon and demonstrating the transosseous-equivalent suture bridge repair with medial and lateral row anchors correctly tensioned and inserted perpendicular to the bone, creating a strong construct.

Fig 4. (A) Illustration, with the patient in the lateral decubitus position, of the lateral view of the tripod technique. It shows the well-established Speedbridge technique of medial and lateral row anchors pressing the supraspinatus tendon down onto its anatomic footprint on the greater tuberosity of the humerus. The retention of 2 eyelet sutures from the lateral row anchors is used to create the tripod anchor, which is in between and inferior to the lateral row. (B) Coronal illustration, with the patient in the lateral decubitus position, of the right shoulder, showing the tripod technique. It shows the well-established Speedbridge technique of medial and lateral row anchors pressing the supraspinatus tendon down onto its anatomic footprint on the greater tuberosity of the humerus. The retention of 2 eyelet sutures from the lateral row anchors is used to create the tripod anchor, which is in between and inferior to the lateral row. It demonstrates the correct insertion of the anchors perpendicular to the bone.

Fig 5. Intraoperative video still of an arthroscopic repair of a left rotator cuff with the patient in the lateral decubitus position, viewed from the lateral working portal. It demonstrates the final repair construct of a medial and lateral row of anchors secured further by the tripod anchor discussed in this Technical Note.

Fig 6. Coronal illustration, with the patient in the lateral decubitus position, of the right shoulder, demonstrating the final image of the tripod technique. The image shows the forces that are pulling on the construct during movement of the shoulder. The red arrow represents the opposing pull of the tripod anchor against the lateral row. The green arrow represents the pull of the medial row of anchors on the lateral row, and the purple arrow shows the pull of supraspinatus muscle.