Anatomic Rotator Cuff Repair With Dual-Layer Fixation: A Knotless Technique

Background: Arthroscopic rotator cuff repair (ARCR) is performed with increasing frequency in the United States, with at least 500,000 repairs done annually. Dual-layer repair is a rotator cuff repair technique in which the deep and superficial layers are repaired separately. The superior capsule comprises the majority of the deep articular attachment of the rotator cuff footprint, and these fibers have differential excursion to the tuberosity. Delaminated cuff tears are often larger and are a poor prognostic sign; they are less likely to heal. Adapting repair techniques for delamination using dual-layer fixation improves healing rates and clinical results. Indications: The dual-layer fixation technique is indicated in larger cuff tears with delamination and differential excursion of articular (medial) rotator cuff and bursal (lateral) fibers. Technique Description: This rotator cuff repair technique demonstrates dual-layer fixation of the rotator cuff to the footprint using a knotless technique. This technique allows anatomic reduction of the medial cuff and superior capsule fibers, which have less excursion, and the bursal more superficial fibers, which mobilize to the lateral aspect of the tuberosity. This technique does not require additional anchors, minimizes suture use, avoids knot stacks within the substance of the cuff, and provides additional points of fixation in the construct. Results: Independent fixation of the deep capsular layer improves both clinical and radiographic outcomes when compared with an en masse suture bridge technique. Discussion: Dual-layer fixation is technically simple using a knotless suture mechanism, minimizing suture within the substance of the cuff while providing additional points of fixation and precise reduction of the articular fibers. This technique may improve clinical results and healing rates after ARCR. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.