Technical Note| Volume 23, ISSUE 4, P440.e1-440.e4, April 2007

Arthroscopic Rotator Cuff Repair Using a Triple-Loaded Suture Anchor and a Modified Mason-Allen Technique (Alex Stitch)


      Surgical repair of the rotator cuff must have good resistance and should restore the tendon footprint. To attain this goal, a stitch with a strong biomechanical profile that avoids tissue strangulation should be used. We describe an arthroscopic suture technique undertaken to repair rotator cuff tears with a single triple-loaded suture anchor. The technique consists of a combination of a horizontal mattress and 2 vertical simple sutures that are positioned medial to the mattress suture. The suture anchor used is the 5-mm self-tapping ThRevo (Linvatec). This anchor is loaded with 3 sutures: 2 No. 2 nonabsorbable braided polyester sutures of different colors and a central high-strength No. 2 polyethylene suture. The shape of the anchor eyelet permits all 3 sutures to glide freely. A modified Mason-Allen technique (Alex stitch) that combines a horizontal side-to-side suture and 2 simples sutures as vertical loops is used. With use of the Spectrum suture passing device and shuttle relay system (Linvatec), both limbs of the centrally located polyethylene suture are passed through the cuff from bottom to top, approximately 1 cm from the tendon edge. This suture is not immediately tied. Next, with use of the same system, the other 2 sutures are placed medially and over the previous horizontal suture. Simple sutures are placed at an approximately 30° angle from the center of the anchor; 1 is placed anterior and the other posterior. The sutures are tied through the lateral portal. The mattress horizontal central stitch is always tied first, followed by the 2 vertical sutures. The horizontal mattress suture serves as a “rip stop stitch” and theoretically reduces the possibility of cutting out of the simple sutures.

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        • Mansat P.
        • Cofield R.H.
        • Kersten T.E.
        • Rowland C.M.
        Complications of rotator cuff repair.
        Orthop Clin North Am. 1997; 28: 205-213
        • Rossouw D.J.
        • McElroy B.J.
        • Amis A.
        • Emery R.
        Biomechanical evaluation of suture anchors in repair of the rotator cuff.
        J Bone Joint Surg Br. 1997; 79: 458-461
        • Gerber G.
        • Schneeberger A.G.
        • Perren S.M.
        • Nyffeler R.W.
        Experimental rotator cuff repair: A preliminary study.
        J Bone Joint Surg Am. 1999; 81: 1281-1290
        • Gerber G.
        • Schneeberger A.G.
        • Beck M.
        • Schlegel U.
        Mechanical strength of repairs of the rotator cuff.
        J Bone Joint Surg Br. 1994; 76: 371-380
        • Ma C.B.
        • MacGillivray J.D.
        • Clabeaux J.
        • Lee S.
        • Otis J.C.
        Biomechanical evaluation of arthroscopic rotator cuff stitch.
        J Bone Joint Surg Am. 2004; 86: 1211-1216
        • Apreleva M.
        • Ozbazdar M.
        • Fitygibbons B.A.
        • Warner J.J.P.
        Rotator cuff tears: The effect of the reconstruction method on three-dimensional repair site area.
        Arthroscopy. 2002; 18: 519-526
        • Burkhart S.S.
        The deadman theory of suture anchors: Observations along a south Texas fence line: Technical note.
        Arthroscopy. 1995; 11: 119-123
        • Scheibel M.T.
        • Habermeyer P.
        A modified Mason-Allen technique for rotator cuff repair using suture anchors.
        Arthroscopy. 2003; 19: 330-333
        • Lo I.K.
        • Burkhart S.S.
        Double-row arthroscopic rotator cuff repair: Re-establishing the footprint of the rotator cuff.
        Arthroscopy. 2003; 19: 1035-1042
        • Burkhart S.S.
        Arthroscopic treatment of massive cuff tears.
        Clin Orthop. 2001; 390: 107-118
        • Mazzocca A.D.
        • Millett P.J.
        • Guanche C.A.
        • Santangelo S.A.
        • Arciero R.A.
        Arthroscopic single-row versus double-row suture anchor rotator cuff repair.
        Am J Sports Med. 2005; 33: 1861-1868
        • Mac Gillivray J.D.
        • Ma C.B.
        An arthroscopic stitch for massive rotator cuff tears: The Mac stitch.
        Arthroscopy. 2004; 20: 669-671
        • Bungaro P.
        • Rotini R.
        • Traina F.
        • et al.
        Comparative and experimental study on different tendinous grasping techniques in rotator cuff repair: A new reinforced stitch.
        Chir Organi Mov. 2005; 90: 113-119