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Arthroscopic transosseous suture anchor technique for rotator cuff repairs

The skin is incised 1-2 cm distal to the lateral portal. A transosseous tunnel is created through the greater tuberosity by a sharp penetrator (a specially designed device, Alter-Fit Zagreb, Croatia), entering 1.5-2 cm distal to the top of the greater tuberosity. The penetrator exits medially, between the tip of the greater tuberosity and the articular surface of the humeral head, in the middle of the footprint. The camera is placed in the lateral portal or in the posterior portal, depending on the possibility of visualization of the footprint and the lateral portion of the greater tuberosity at the site of the penetrator entry. The first anchor, a 5.0mm Spiralok with oval-shaped dual suture eyelet (DePuy Mitek, Norwood, USA) is placed at the penetrator's exit site on the footprint. By specially designed suture leader (Alter- Fit Zagreb, Croatia) the lateral limb of the suture in the anchor (white suture), which passes through the previously created transosseous tunnel, is taken from the anchor and pulled out. The other suture end is passed through the supraspinatus tendon by means of a special instrument, Espresso, (DePuy Mitek, Norwood, USA), through the lateral or anterior lateral portal, depending on the placement of the camera. The second suture, placed superficially in the anchor, (green suture), is passed from the anchor through the supraspinatus tendon with Espresso instrument, as a mattress suture (Figure 1). If more anchors are required, the procedure should be repeated. The transosseous suture limb and the suture limb that is passed through the supraspinatus tendon are tied through the lateral portal. The knot tying is then performed with a sliding Delimar knot (1), with the arm in abduction of approximately 30-40 degrees. The mattress suture, passing through the supraspinatus tendon, is tied through the anterior lateral portal. The knot tying procedure is repeated depending on the number of anchors.

arthroscopy; shoulder; rotator cuff; transosseous suture

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