All-Suture Repair for Compressive Rotator Cuff Tears: Reducing the Traction of the Tissue  Néstor A. Zurita Uroz, M.D., Ph.D., Ferran Abat, M.D., Ph.D., Angel Calvo Diaz, M.D., Ph.D.  Arthroscopy Techniques  Volume 6, Issue 2, Pages e499-e503 (April 2017) DOI: 10.1016/j.eats.2016.11.005 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient positioning. Right shoulder. Patient positioned in the lateral decubitus position with 5 kg traction of the arm, 45° of abduction, and 20° of flexion. Arthroscopy Techniques 2017 6, e499-e503DOI: (10.1016/j.eats.2016.11.005) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Right shoulder. Skin marking for the portal placement. Arthroscopy Techniques 2017 6, e499-e503DOI: (10.1016/j.eats.2016.11.005) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Right shoulder in the lateral decubitus position. Direct vision through the anterior portal with a cannula. (A) The first implant (medial row) is introduced through the percutaneous accessory portal. (B) A direct suture penetrator grabber with a maximum angle of 25° was introduced through the Neviaser portal. (C and D) Tendon is pierced with the penetrator grasping, through the tendon, the 2 sutures placed in the medial row. (E and F) Through the Neviaser portal, the most lateral part of the tendon is pierced with the direct suture penetrator catching one of the threads and recovering it through the same portal. Arthroscopy Techniques 2017 6, e499-e503DOI: (10.1016/j.eats.2016.11.005) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Right shoulder in the lateral decubitus position. Direct vision through the anterior portal. (A) Threads of the implant from the lateral row (striped ones) are recovered through one of the portals (posterior or anterior). (B and C) Threads were fixed with a traction knot. (D) The grasper is inserted through the posterior portal to pick up one of the threads of the medial row and one of the remaining 2 from the lateral row to be retrieved through the same posterior portal. (E and F) Knots were performed outside of the joint and later fixed in the correct position. (G) The 2 sutures that remain free in the posterior portal are retrieved. (H and I) After that, the sutures were tied on the cuff with simple knots, ending the suture bridge and maintaining the compressive force. Arthroscopy Techniques 2017 6, e499-e503DOI: (10.1016/j.eats.2016.11.005) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Right shoulder in the lateral decubitus position. Direct vision through the anterior portal. (A-F) Sawbones demonstration of the suture bridge configuration with 3 anchors as described in the technique reported. Arthroscopy Techniques 2017 6, e499-e503DOI: (10.1016/j.eats.2016.11.005) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions