Suture Management and Passage

  • Richard K.N. Ryu


As arthroscopic rotator cuff repair techniques become ubiquitous, mastering basic surgical steps is of paramount importance if satisfactory results are to be achieved on a consistent basis. We have learned that the critical steps in an arthroscopic rotator cuff repair consist of (1) appropriate portal placement for optimal viewing and for manipulation of tissue and equipment;1,2 (2) tear pattern recognition, such that appropriate mobilization techniques are utilized to complete an anatomical repair without undue tension;2 (3) rotator cuff mobilization, including supraglenoid release, subacromial space release, possible anterior interval release, or double interval release, to include the infraspinatus and supraspinatus junction;3, 4, 5 (4) greater tuberosity preparation, in which the subchondral bone is not violated, accompanied by anchor insertion oriented at 45° to the long axis of the humerus, to maximize pullout strength;6 (5) suture management and passage, either retrograde or antegrade, through the free edge of the tear or in a side-to-side pattern, in which tissue is captured and coapted without sacrificing pullout strength;7,8 (6) deft knot tying such that loop and knot security are achieved while re-attaching the edge of the cuff tear to the anatomical footprint.6


Rotator Cuff Free Edge Great Tuberosity Curve Arrow Arthroscopic Repair 
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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Richard K.N. Ryu
    • 1
  1. 1.Santa BarbaraUSA

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