Double Pulley-Triple Row Technique for Arthroscopic Rotator Cuff Repair: A Technical Note

Arthroscopic rotator cuff repair is the gold standard for treatment, but current techniques have shortcomings, especially for larger tears. Single-row repairs often fail to fully restore the footprint, leading to high retear rates. Although triple-row and double-row repairs show promise, concerns regarding retear persist. Biomechanical studies favor triple-row repair for better coverage and pressure distribution. Techniques such as linked double-row and double-pulley methods enhance strength. Secondary cuff failures near the musculotendinous junction are commonly caused by stress concentration. To address these challenges, novel methods have employed linked, knotless, and bridging constructs. Our approach, the double pulley-triple row, aims to minimize retears, especially at the musculotendinous junction, and provides uniform pressure distribution, which is particularly beneficial for large tears. The surgical steps involve standard arthroscopic procedures with specific instruments. Despite these challenges, our method combines proven techniques for optimized outcomes and promising improved results in rotator cuff repair.