{'fraction_non_alphanumeric': 0.017879161528976572, 'fraction_numerical': 0.0, 'mean_word_length': 5.242307692307692, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Arthroscopic Knotless Double-Row Rotator Cuff Repair Without Side-to-Side Suture Placement

We describe a unique arthroscopic approach for repairing U-shaped and other longitudinal component rotator cuff tear patterns using a double-row construct, which typically eliminates the need for secondary side-to-side sutures. After recognition of a longitudinal component rotator cuff tear and appropriate tendon mobilization, a medial nail is placed percutaneously, directly through the anterior cuff (transtendon insertion) and then inserted into the medial edge of the greater tuberosity adjacent to the articular margin. This is repeated for the posterior leaf. A lateral knotless anchor is then placed anteriorly, in line with the nail and just lateral to the lateral edge of the anaomic footprint of the rotator cuff. One suture limb from each medial nail is then wrapped around the locking mechanism, hand tensioned under direct visualization, and locked in the anchor. This is repeated for a posterior lateral anchor achieving both a crossed pattern and an uncrossed medial-to-lateral suture anteriorly and posteriorly, with anatomic fixation of the cuff tendon. The longitudinal component is reduced by the crossing pattern of the sutures without the need for additional sutures. Each limb is also fixed medial to lateral by the uncrossed suture pair. Biomechanical studies have shown that double-row fixation is superior in initial fixation strength and footprint coverage. Additional advantages are that this is completely knotless and can be done without the separate step of passing suture through the rotator cuff.