Arthroscopy Technique: Repair of Musculotendinous Junction Rotator Cuff Tears in the Shoulder Using a Dynamic Convergence Suture Bridge Technique

Figures

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  Fig 1. Arthroscopic view of left shoulder from standard anterior viewing portal. A standard diagnostic arthroscopy was performed showing a large retracted type A myotendinous junction tear with a medial stump of supraspinatus muscle and tendon lateral to the tear.

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  Fig 2. Schematic diagram depicting a type A myotendinous junction tear of the supraspinatus tendon.

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  Fig 3. Arthroscopic view of left shoulder from standard anterior viewing portal. A radiofrequency device is used to prepare the medial-row anchor footprint.

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  Fig 4. With the camera maintained at the anterior portal, a medial-row triple-loaded suture anchor (HEALIX ADVANCE; DePuy Mitek) is inserted onto the humeral head in between the margins of the MTJ tear. Sutures are subsequently passed through the medial and lateral edge of the torn tendon. There are 3 different-colored sutures—white, green, and blue. (MTJ, musculotendinous junction.)

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  Fig 5. With the arthroscope positioned at the anterior portal, one limb of the white suture is passed through the medial edge of the supraspinatus musculotendinous junction tear using a suture passer (EXPRESSEW; DePuy Mitek).

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  Fig 6. Arthroscopic view of left shoulder from anterior portal. A suture retriever device (DePuy Mitek), entering from the lateral working portal, is used to retrogradely retrieve the second limb of the white suture through the lateral edge of the supraspinatus tendon stump.

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  Fig 7. For the green sutures, both suture limbs are first retrogradely retrieved and threaded through the lateral aspect of the tendon using a bird-beak suture retriever device (Penetrating Grasper; DePuy Mitek). The arthroscope is maintained at the anterior viewing portal.

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  Fig 8. Arthroscopic view of left shoulder from anterior portal. Following retrograde retrieval, both limbs of green sutures are now on the lateral aspect of the tendon, exiting through a lateral portal. Using a bird-beak suture passer device (Penetrating Grasper; DePuy Mitek), each suture limb is then passed individually back into the lateral tendon in antegrade fashion, creating a mattress suture configuration on this aspect.

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  Fig 9. With aid of a suture passer device (EXPRESSEW; DePuy Mitek), each green suture limb from the mattress suture is subsequently passed through the medial tendon in antegrade fashion. The arthroscope is maintained at the anterior viewing portal.

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  Fig 10. Schematic diagram of green sutures configuration, which gives rise to a dynamic margin convergence pattern, brining tight apposition of both medial and lateral edges of the musculotendinous junction tear.

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  Fig 11. Arthroscopic view of left shoulder from anterior portal following completion of dynamic convergence pattern for the green suture limbs. The blue suture limbs from the medial-row anchor being passed through the medial and lateral margins of the supraspinatus tendon tear, in a similar fashion to the white sutures.

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  Fig 12. Schematic diagram of blue sutures configuration, which gives rise to a static margin convergence pattern of repair, upon tying both ends of the suture limbs.