1. Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule 
Tomoyuki Mochizuki, M.D., Ph.D., Akimoto Nimura, M.D., Ph.D., Takashi Miyamoto, M.D., Ph.D., Hideyuki Koga, M.D., Ph.D., Keiichi Akita, M.D., Ph.D., Takeshi Muneta, M.D., Ph.D. 
Arthroscopy Techniques 
Volume 5, Issue 5, Pages e1129-e1134 (October 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Independent repairs of the superficial layer (infraspinatus) and deep layer (articular capsule). The deep layer (black asterisk) and superficial layers (black star) are pulled in different directions (arrows). (A) Deep layer is treated as the articular capsule. It is pulled laterally across the glenoid. (B) Superficial layer is treated as the infraspinatus. It is pulled anterolaterally to the bicipital groove. (ISP, infraspinatus muscle; SSP, supraspinatus muscle.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Procedure of independent repairs for delamination, posterolateral view of right shoulder. (A) The deep layer (black asterisk) is attached to the medial margin of the glenoid using 4 simple sutures from 2 medial anchors. (B) Same color paired limbs of 4 knots are passed over mainly the posterior leaf of the superficial layer at equal intervals. (C) A push-in anchor loaded with 1 thread each of 4 knots is placed on the anterolateral corner of the greater tuberosity to pull the superficial layer anterolaterally. (D) Another push-in anchor loaded with the remaining threads is pushed on the posterior corner of the greater tuberosity. In the case a dog ear is formed in the anterior area, the dog ear is flattened by a simple suture using the thread from the anteriorly placed push-in anchor. (ISP, infraspinatus muscle; SSP, supraspinatus muscle; TM, teres minor muscle.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Suture process of the deep layer (articular capsule). A right shoulder with delaminated rotator cuff tears, as viewed from the posterolateral portal. (A) Anterior site of the deep layer is grasped by using the SHUTT suture punch system (Conmed Linvatec, Utica, NY), loaded with a No. 2-0 monofilament suture (PROLENE; ETHICON, Somerville, NJ) from the anterolateral portal. (B) A suture relay is performed intra-articularly. (C) A suture is passed over at the most anterior site of the deep layer. (DL, deep layer; SL, superficial layer.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Repair process of the deep layer (articular capsule). A right shoulder with delaminated rotator cuff tears, as viewed from the posterolateral portal. (A) Suture process of the deep layer is performed 4 times from anterior to posterior, after completion of the suture relay. (B) The sutures are retrieved from within a cannula inserted from the anterolateral portal and subsequently tied using a standard sliding knot with 2 reversed half-hitches from posterior to anterior. (C) Eight suture limbs are left without cutting for repair of the superficial layer. (DL, deep layer; SL, superficial layer.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
Suture process of the superficial layer (infraspinatus). A right shoulder with delaminated rotator cuff tears, as viewed from the posterolateral portal. (A) The superficial layer is grasped and pulled anterolaterally and evaluated as to whether it can reach the lateral edge of the greater tuberosity. (B) By pulling the superficial layer anterolaterally using a grasper inserted from the anterolateral portal, a Suture Grasper 60° (Depuy Synthes Mitek Sports Medicine, Raynham, MA) is inserted through the posterior portal and the posterior one-third of the posterior margin of the superficial layer is penetrated. (C) Suture grasper is led between the deep and superficial layers and pick up 2 same colored limbs of the knot, which are tied to the deep layer. (SL, superficial layer.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
Repair process of the superficial layer (infraspinatus). (A) After inserting a cannula into the anterolateral portal, 1 each of 2 limbs from each suture (total 4 limbs) is retrieved within a cannula from the anterolateral portal. (B) Four different colored limbs are loaded into the islet of a push-in anchor (Swivelock anchor; Arthrex, Naples, FL). The anchor is then placed on the lateral corner of the anterior side of the greater tuberosity, just posterior to the bicipital groove. (C) The remaining limbs are retrieved within a cannula from the anterolateral portal. (D) These limbs are loaded and placed on the lateral corner of the posterior side of the greater tuberosity in a fashion similar to complete repair. (DE, dog ear; SL, superficial layer.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
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8. Fig 7
Flattening process of the dog ear. (A) The case of a dog ear that is formed in the anterior area. (B, C) The dog ear is flattened by a simple suture using the thread from the anteriorly placed push-in anchor. (DE, dog ear.)
Arthroscopy Techniques 2016 5, e1129-e1134DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions