The video presents a step‑by‑step instructional demonstration of a knotless ripstop repair for massive rotator cuff tears of the right shoulder, viewed from a posterior portal. The surgeon first addresses a limited tendon stump after prior biceps tenodesis and subscapularis repair, then places two inverted‑mattress sutures using a FiberTape and a Tiger Tape. For each mattress suture a FiberLink suture is passed medial to the tape, creating a cinch that provides knotless fixation. The sutures are retrieved laterally and secured into a 5.5 mm biocomposite Sylvalock vented anchor placed in a bone socket in the humeral head. Bone vents are created in the tuberosity to promote biological healing, and the anchor is tensioned until its threads engage the bone. The same sequence is repeated anteriorly, completing a low‑profile, knotless ripstop construct that distributes load, protects poor‑quality tendon tissue, and offers the same number of passes as a traditional triple‑loaded single‑row repair but with added ripstop benefits.
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This video demonstrates a technique for knotless ripstop repair. This is an alternative to a triple-loaded single-row repair. Two inverted mattress sutures are placed in the rotator cuff, a FiberTape and a Tiger Tape. Next, a FiberLink suture is passed medial to each of those. We usually place these one at a time, that is, place the tape, then place the FiberLink, and then take those sutures out to the side and then place the second Tiger Tape, and then FiberLink. Then those sutures are secured into a bone socket in the humeral head. This is usually with a 5-5 Silvlock anchor, and there's your final repair. You can see there's the same number of passes as a single-row triple-loaded repair, but it has the benefits of a ripstop. This is a right shoulder now viewed from a posterior viewing portal. So we have a limited tendon stump, that is, there is tendon loss, which is often the case in massive rotator cuff tears. We've already performed a biceps tendesis anteriorly and repaired the subscapularis tendon. We take those sutures from the biceps tendesis and tie those down anteriorly to reinforce the rotator cable, and now we're going to move to our ripstop. The Tiger Tape is introduced and passed in an antegrade fashion. Second limb is passed to complete the inverted mattress suture. A FiberLink suture is then passed medial to those sutures. The cinch is then created and those sutures are retrieved out another cannula. Then place a second inverted mattress suture and a FiberLink medial to that to create our knotless ripstop. Then we simply take these out laterally and complete our repair. We use the cannulas to guide, to determine the location for our bone socket. Bone socket is created, then we can insert our 5.5 biocomposite Sylvalock anchor. One step that's not shown here is we typically will create bone vents in the tuberosity with a small punch to encourage biological healing. When removing that punch, we like to hold a cannula in place so we can then take the anchor straight down to the bone socket. Slack is removed as the eyelet is inserted into the bone socket. Once all that slack is removed, the anchor is impacted into place until the threads of the anchor engage the bone itself. The anchor then can be twisted and advanced down the shaft to the eyelet. This is a vented anchor. Also to encourage biological healing, and the limbs are cut short. We then repeat the process anteriorly, incorporating the Tiger Tapes and the FiberLink suture anteriorly. And this completes our knotless ripstop repair. Low-profile knotless repair for poor quality tissue.
