Suturetape

All patients were placed in the lateral decubitus position and underwent
diagnostic arthroscopy utilizing a standard posterior viewing portal and an
anterior working portal within the rotator interval. Concomitant pathology was
noted and addressed on a case-by-case basis to include debridement or repair of
the labrum and rotator cuff.
The location of the capsular tear was carefully assessed, taking note of
continuation to either the humeral or glenoid attachment. All tears were found
within the axillary pouch between the anteroinferior and posteroinferior
glenohumeral ligaments (Figure
1A). Accessory anteroinferior or posteroinferior portals were placed
to facilitate suture passage. Medially based tears were repaired from lateral to
medial in a “baseball stitch” fashion using a nonabsorbable 1.3-mm tape suture
(SutureTape; Arthrex) successively passed between leaflets using an
appropriately curved 25-degree suture shuttling device (SutureLasso; Arthrex)
(Figure 1B). Suture
limbs were tensioned and then secured at the glenoid insertion with a 2.9-mm
knotless anchor (PushLock; Arthrex) (Figure 1C). Laterally based tears were
repaired in a reverse fashion from medial to lateral with eventual fixation into
the humeral insertion.

The LLS was performed with a 1.3-mm-wide SutureTape reinforced with a 4-0 suture (Arthrex). The LLS was started by wrapping the suture around the tendon, followed by penetration of the center of both the reinforced SutureTape and tendon to make a locking loop at the proximal starting point. For each subsequent throw, a simple wrapping suture was performed and followed by needle penetration of wrapping suture, the reinforced suture tape, and tendon together. Each wrapping throw and locking loop was performed at 5-mm intervals with hand tension to eliminate excess suture material within the loops (Figs. 1B, 2, and 3).

After detachment of the proximal hamstring insertion site, a 4.5-mm spade drill tip was utilized to drill 3 anchor tunnel sites perpendicular to the tendon insertion site, and these were subsequently tapped in all specimens. A fully threaded double-loaded 5.5 mm–diameter × 14.7 mm–long anchor (BioComposite Corkscrew; Arthrex) was then inserted into each of the tunnel sites. The suture material consisted of a 1.3 mm–wide ultra-high molecular weight polyethylene nonabsorbable suture (SutureTape; Arthrex). Previous marking of the bone-tendon interface with indelible blue marker allowed us to reapproximate our repair in an anatomic fashion. One limb of each suture pairing was run through the tendon in a Krackow running-locking fashion, and its matching limb was simply passed just proximal to the Krackow pattern in a deep to superficial trajectory to allow the tendon to slide and reduce to its bony insertion site along this suture strand. This was performed at the distal 2 anchor sites before completing the repair with the proximal suture anchor, all with the identical technique (Figure 2).