Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

William R. Mook, Joshua A. Greenspoon, Peter J. Millett*
The Steadman Philippon Research Institute (W.R.M, J.A.G., P.J.M.) and The Steadman Clinic (W.R.M., P.J.M.), Vail, Colorado, U.S.A

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© Mook et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Center for Outcomes-Based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000 Vail, CO 81657, U.S.A; E-mail:



Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row.


The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct.


The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots.


Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

Keywords: Double row, knotless repair, rotator cuff, shoulder transosseous.