An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge Philipp R. Heuberer,

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An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge Philipp R. Heuberer, M.D., Leo Pauzenberger, M.D., Daniel Smolen, M.D., Roman C. Ostermann, M.D., Werner Anderl, M.D. Arthroscopy Techniques Volume 7, Issue 1, Pages e7-e12 (January 2018) DOI: 10.1016/j.eats.2017.08.043 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopic view of a right shoulder in the beach chair position from the lateral portal visualizing a complete supraspinatus tear (SSP) and partial infraspinatus tear (ISP) with a delamination (red circle showing the inferior layer) with empty footprint (asterisk) before (A) and after (B) repositioning (red arrow). Arthroscopy Techniques 2018 7, e7-e12DOI: (10.1016/j.eats.2017.08.043) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Fiberlink suture with a closed loop on one end (asterisk) and a straight limb on the other end (arrow). Arthroscopy Techniques 2018 7, e7-e12DOI: (10.1016/j.eats.2017.08.043) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic view of a right shoulder in the beach chair position from the lateral portal showing (A) Fiberlink sutures shuttled through the inferior layer (asterisk) with an antegrade suture passer (arrow). (B) Bringing the straight end of the suture through the loop and pulling on it closes the cinch (arrow) and bringing the inferior layer (asterisk) over the anchor at the cartilage-bone interface, whereas the superior layer (dot) remains untouched. Because of the friction between the suture filaments, the layer stays almost by itself in place. (C) After the inferior layer is secured in cinch configurations, the remaining suture limbs (flash) are shuttled through the superior layer (dot) with a suture passer (arrow). (D) The free ends of the Fiberlink sutures (flash) are then shuttled through the superior layer (dot). (E) In a last step, the Fiberlink sutures (flash) are then secured laterally with a knotless suture anchor in a transosseous-equivalent-type technique (arrow). (F) The intra-articular view shows an anatomic re-establishment of the superior capsule (arrow) at the cartilage-bone interface (asterisk). Arthroscopy Techniques 2018 7, e7-e12DOI: (10.1016/j.eats.2017.08.043) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions