Arthroscopic Rotator Cuff Repair Technique Incorporating Remnant Tendon Insertion

Rotator cuff repair (RCR) in massive tears often is limited by excessive repair tension and inadequate biological healing. Traditional techniques involve debriding the greater tuberosity and resecting remnant tendon tissue. However, this may eliminate valuable biological and structural elements. This Technical Note describes an arthroscopic approach for large RCR that includes the lateral remnant tendon into a double-row construct. The goal is to reduce repair stress while preserving native enthesis and vascularity. After conventional diagnostic arthroscopy and subacromial decompression, the medial cuff is mobilized and secured to a medialized footprint using double-loaded anchors. The lateral residual tendon is retained and incorporated into the "pants-over-vest" configuration. A lateral-row suture bridge compresses the natural insertion point. Preserving the remaining tendon stump can maintain vascular supply and potentially transfer progenitor cells to the healing site. This approach shortens the tendon-to-footprint distance, allowing for low-tension anatomic restoration. Previous animal and histology studies have demonstrated the therapeutic effects of remnant preservation. This method for transtendinous RCR is biologically beneficial and reduces tension, potentially increasing healing and functional outcomes. Further research is needed to determine its long-term clinical efficacy.