Double double-pulley triple row technique for arthroscopic rotator cuff repair: a technical note

The double double-pulley triple-row (DDPTR) technique is an arthroscopic rotator cuff repair method designed for large-to-massive reparable tears for which controlled reduction and secure medial fixation are difficult. DDPTR modifies the previously described double-pulley triple-row (DPTR) concept by adding a third medial-row anchor, allowing two independent double-pulley systems (posterior and anterior) that share a central medial anchor. After reduction with a middle-row knotless anchor, two lateral knotless anchors complete the suture-bridge construct. This Technical Note describes the indications, footprint preparation, anchor placement, and pulley suture management for DDPTR. The biomechanical and clinical advantages of this technique remain to be validated.