Arthroscopic Double-Row Rotator Cuff Repair Using a Knotless, Interconnected Technique

The surgical techniques used for rotator cuff repair have evolved over the past 3 decades. Technical innovations have contributed to improved clinical outcomes following repair. Recently, double-row repairs have demonstrated substantial biomechanical advantages when compared with single-row repairs, including decreased gap formation, increased ultimate load to failure, and improved footprint coverage. Knotless transosseous equivalent rotator cuff repair has emerged as an alternative to knotted constructs. The lack of medial knots with the knotless repairs is thought to improve vascular inflow, and the wider suture materials may prevent suture cut through of the repaired cuff tendon. Furthermore, knotless techniques may decrease operative time and may eliminate postoperative knot impingement within the subacromial space. This article serves to highlight our preferred surgical technique for the knotless double-row, transosseous equivalent rotator cuff repair and to review the current literature pertaining to the clinical outcomes following knotless and knotted repair constructs.