With advances in arthroscopic surgery, several techniques have been developed to increase the tendon–bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. On the basis of magnetic resonance imaging (MRI) findings, the double-row repair is a more anatomic construct, which better restores the native structures of the rotator cuff footprint. However, this does not seem to translate into superior clinical outcomes, except for large-to-massive tears (>3 cm), in which the double-row technique provides better clinical outcomes compared with the single row. For mobile crescent-shaped cuff tears, we propose the double-row fixation with anchors and knotted sutures as the standard for arthroscopic rotator cuff repair.

The double-row repair is similar to that described by Lo and Burkhart. Two double-loaded 5.0-mm screws are inserted just lateral to the articular surface of the humeral head, with a center-to-center distance of approximately 1.5 cm in the anterior-to-posterior direction. The first medial anchor is inserted 5 mm from the bicipital groove. The suture strands from each medial anchor are passed approximately 7 mm apart in a mattress fashion. The lateral row consists of two double-loaded 5.0-mm screw suture anchors just lateral to the “drop-off” of the greater tuberosity, with a center-to-center distance of approximately 1.5 cm in the anterior-to-posterior direction. The suture from each lateral anchor is passed through the tendon as a simple stitch. All knots are completed with a static six-throw surgeon’s knot.

Several imaging techniques are available to study the rotator cuff: