Arthroscopic transhumeral rotator cuff repair: Giant needle technique

An arthroscopic transhumeral rotator cuff repair technique is presented with which the same type of cuff repair can be performed as with an open standard procedure. After adequate arthroscopic subacromial decompression, a bone trough is made on the greater tuberosity and a hole is punctured with a sharp hook. A special bone-cutting needle with a suture (giant needle) is then passed through the skin and deltoid muscle in front of the acromion, through the torn tendon, the hole in the trough, and out through the lateral cortical surface through the deltoid and skin. The suture limbs are pulled out through the instrumentation portal and a sliding knot is made to close the defect. No hardware implants are used and the procedure is not technically complicated. During surgery only two thirds of the steps used for open repair were required. With experience, a large tear was repaired as well as with an open repair. The advantages of this technique are that the strength of cuff fixation does not rely on the quality of the bone in the greater tuberosity, there is no need for complicated suture passing techniques through the rotator cuff, and it offers the same fixation technique as the traditional open repair.