Double-pulley Technique Research Articles

Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions.

The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up. Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union. Level III.

Arthroscopic Modified Double-Pulley Suture-Bridge Repair of Medium-Sized Supraspinatus Tendon Tears

At present, the repair patterns for medium-sized supraspinatus tendon tears are double- and single-row repairs. However, the limitations of double-row repair include excessive anchor implantation and incremental surgical cost and time, whereas a deficient tendon-bone contact area exists with single-row repair. The modified double-pulley suture-bridge repair presented in this study is an arthroscopic technique using 3 double-loaded suture anchors combined with a double-pulley technique to form a hybrid repair pattern with a double row as the mainstay and a single row as the supplement. In the treatment of medium-sized tendon tears, the modified double-pulley suture-bridge repair can not only maximize the tendon-bone contact area but also lower the surgical cost and shorten the operative time. The surgical technique is described, including pearls and pitfalls, as well as advantages and disadvantages.

Dynamic Anterior Stabilization of the Shoulder: Onlay Biceps Transfer to the Anterior Glenoid Using the Double Double-Pulley Technique

The treatment of anterior glenohumeral instability includes several surgical options, ranging from soft tissue to bony procedures—open or arthroscopic. In arthroscopic dynamic anterior stabilization (DAS) of the shoulder, the long head of the biceps is transferred to the anterior glenoid through a subscapularis tendon split. The biceps may be fixed either in an inlay or in an onlay position. Inlay DAS theoretically increases anterior glenohumeral stability through 3 different effects: the hammock effect, sling effect, and the tensioning effect. Onlay DAS may additionally increase stability through a labroplasty effect, produced by the onlay positioning of the biceps on the anterior glenoid rim. The current technical note presents tips and tricks, and pearls and pitfalls, to reproducibly perform onlay DAS using all-suture anchors and the double double-pulley technique.

Onlay Dynamic Anterior Stabilization With Biceps Transfer for the Treatment of Anterior Glenohumeral Instability Produces Good Clinical Outcomes and Successful Healing at a Minimum 1 Year of Follow-Up

To report the results of the onlay dynamic anterior stabilization (DAS) using the long head of biceps (LHB) and the double double-pulley technique for the treatment of anterior glenohumeral instability (AGI) with ≤20% glenoid bone loss (GBL). From September 2018 to December 2021, patients with AGI and ≤20% GBL were enrolled in a prospective study on DAS and followed for a minimum of 1 year. The primary outcomes were Western Ontario Shoulder Instability Index, Rowe score, range of motion, and strength. The secondary outcomes were ability to return to play (RTP), RTP at same level, lack of recurrence of instability, successful LHB healing, and lack of complications. Magnetic resonance imaging was used to measure GBL, Hill-Sachs interval, glenoid track, and assess LHB integrity. Eighteen consecutive patients underwent DAS. Fifteen patients had a minimum follow-up of 12 months (mean, 23.93 ± 13.67 months). In total, 12 were male and 3 female patients; 73.3% practiced recreational sports; mean age at surgery was 23.40 ± 6.53 years; mean number of dislocation episodes were 10.13 ± 8.42; mean GBL was 8.21 ± 7.39% (range, 0-20.24%); mean Hill-Sachs interval was 15.00 ± 2.96 mm; and mean glenoid track was 18.87 ± 2.57mm. The mean improvement in the Western Ontario Shoulder Instability Index and Rowe score (959.27 ± 386.70 and 74.00 ± 22.22 points) was significant (P < .001 and P < .001) and more than 6 times greater than the minimum clinically important difference. The mean improvement in active elevation, abduction, and external and internal rotation (23.00 ± 27.76°, 33.33 ± 43.78°, 8.33 ± 13.58°, and 0.73 ± 1.28 points) was significant (P= .006, P= .011, P= .032, and P= .044). RTP rate was 93.33%. RTP at same level was 60.00%. One patient with hyperlaxity had a redislocation (6.7% recurrence). No complications were reported. Each magnetic resonance imaging scan showed successful LHB healing to the anterior glenoid. At a minimum of 1-year follow-up, DAS produces significant and clinically important improvements in shoulder function, successful LHB healing, and is safe for the treatment of AGI with ≤20% GBL without severe hyperlaxity. IV, therapeutic case series.

Arthroscopic Double-Row Rotator Cuff Repair With Box Configuration

Background: Arthroscopic transosseous-equivalent (TOE) techniques may offer additional advantages, including a more efficient surgery with a self-reinforcing construct with equivalent clinical results to medial knotted TOE repair for rotator cuff tears (RCTs). Indications: An arthroscopic knotless double-row (DR) rotator cuff repair (RCR) using FiberTak RC anchors for medial row fixation with box configuration may be an appropriate construct for operatively indicated small-to-moderate full-thickness RCTs. Technique: Our modified technique uses TOE repair principles to address RCTs too small for traditional 4.75-mm anchors using medial row fixation and too large to apply a single medial to lateral anchor repair. The patient is placed in a beach chair position. In addition to standard anterior and posterior portals, a lower lateral working portal and a higher posterolateral viewing portal are made. Subsequent to supraspinatus footprint visualization/preparation, two 2.6-mm FiberTak RC anchors each loaded with 1 LabralTape and 1 FiberWire are placed medially. The 4 sets of sutures for one anchor are placed through the rotator cuff tendon together in 1 spot and the process is repeated for the second anchor. One FiberWire from each anchor is then tied extracorporeally and then a double pulley technique is used to compress the medial aspect of the repair at the footprint in a box configuration. Finally, 1 limb of LabralTape from each of the medial anchors along with the corresponding FiberWire is secured through 2 lateral-row 4.75-mm anchors anteriorly and posteriorly to restore the lateral footprint and secure the rotator cuff in TOE box configuration. This modified technique can provide anatomical compression of the rotator cuff tendon at the footprint with additional medial compression achieved by the box configuration while taking advantage of knotless fixation. Results: Postoperatively, a sling is worn for 4 weeks, passive range of motion (ROM) is initiated at 2 weeks, active ROM is begun at 6 weeks, and strengthening at 3 months. Patients may return to full unrestricted activities around 5 to 6 months. Discussion/Conclusion: A modified arthroscopic DR RCR with box configuration is an excellent treatment option for patients with small-to-moderate full-thickness RCT who fail conservative treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Retracted: Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture.

[This retracts the article DOI: 10.1155/2021/4964195.].

Treatment of avulsion fracture of inferior pole of patella with improved angle of anchor and double pulley technique

To evaluate the angle of modified anchor nail placement and the curative effect of double pulley technology for the treatment of extreme avulsion fracture of lower patella. From December 2015 to December 2018, a total of 22 patients(10 males and 12 females) with avulsion fracture of the inferior pole of patella were retrospectively analyzed. The average age was (44.00±15.24) years old(range, 19 to 70 years). All patients were treated with modified anchor angle and double pulley technique. The range of motion(ROM) and Bostman score system were used to evaluate the functional recovery of knee joint. All 22 cases were followed up with an average of (30.86±8.00) weeks (18 to 46 weeks). At the last follow-up, ROM of the affected knee was (130.82±4.69) °, and the contralateral knee was (133.23 ± 3.15) °, there was no significant difference between two groups (P>0.05). The average Bostman score was (28.45±1.41) scores, 18 cases were excellent results, 4 cases were good. Improved anchor placement angle and double pulley technique for treatment of extreme avulsion fracture of lower patella is easy to operate, with satisfactory curative effect and good recovery of knee joint function.

Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures.

ObjectiveTo evaluate the efficacy of the double‐row and double‐pulley technique in treating anterior shoulder glenoid fracture (Ideberg type Ia) using shoulder arthroscopy.MethodsThirty‐six patients with Ideberg type Ia admitted from March 1, 2017, to March 1, 2020, were retrospectively reviewed. Data of the patients' history included age, sex, side of the affected arm, the mean time from injury to surgery, the surgical duration, the average blood loss, and the average total duration of hospital stay. The double‐row and double‐pulley technique was used to repair the scapular glenoid fracture under arthroscopy. Computed tomography (CT) was used to evaluate fracture healing after surgery. The American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the Constant–Murley shoulder function score were used to assess the function of the affected shoulder.ResultsThe surgical duration was 90–150 min, with a mean of 127 min. The average blood loss was 90 mL (range, 60–120 mL), and the average total duration of hospital stay was 9.2 days (range, 3 to 14 days). At 9 months after surgery, the CT results showed that all fractures healed, and all patients returned to their previous levels of activity and regained an excellent range of motion. The visual analog scale (VAS) score was 7.55 ± 1.32 before surgery, and the VAS score significantly decreased to 1.24 ± 0.72 at 12 months after the operation (p < 0.05). The Constant, ASES, and UCLA shoulder function scores were 44.38 ± 2.16, 43.47 ± 12.76, and 21.80 ± 1.16 before the surgery, respectively, which improved to 93.52 ± 2.82, 91.34 ± 8.28, and 33.24 ± 1.64, respectively, in the following 12 months. One patient experienced fat liquefaction. However, no cases of deep venous thrombosis, iatrogenic neurovascular compromise, wound infection, or neurovascular injury were identified.ConclusionThe double‐row and double‐pulley technique for treating Ideberg type Ia under shoulder arthroscopy has minor surgical trauma, reliable fracture reduction and fixation, less postoperative pain, and fewer postoperative complications and significantly improves the patient's shoulder joint function.

SpeedBridge Knotless Double-Pulley Rotator Cuff Repair

Rotator cuff tears remain a common injury, and may require rotator cuff repair, one of the most frequently performed orthopaedic procedures. Achieving an ideal construct during rotator cuff repair is crucial, and while many techniques exist to accomplish this, they are continuously evolving to improve stability and biomechanics of the repaired shoulder. Improving efficiency of the procedure alongside the increasing complexity of innovative techniques remains of the utmost importance. The double-pulley SpeedBridge technique achieves medial fixation in a double-row, transosseus-equivalent repair, and the knotless nature of the technique creates for a low-profile construct and improves overall efficiency. The purpose of this Technical Note is to describe a reproducible and efficient approach to arthroscopic rotator cuff repair using the SpeedBridge knotless double-pulley technique.

Arthroscopic Repair of the Bankart Lesion Using Dual-Row Labral Repair

Background: The most common technique described for bankart repair is the single-row labral repair. Recent interest has been the use of a dual-row, double pulley technique, first described by Zhang et al and popularized by Millett et al as the “bony Bankart bridge” technique. The aim of this study is to report a double-row all-suture labral fixation technique using knotless anchors. Technique: Step 1: glenohumeral debridement, and preparation of the glenoid labral and Bankart. The patient is first placed in the beach-chair position and surface landmarks are created. The standard posterior portal is first created and the glenohumeral joint is evaluated. Once the lesion is identified, the relevant working anterosuperior and anteroinferior portals are established using the outside-in technique. The synovitis is debrided to allow visualization and the labrum is liberated from the anterior glenoid. The Bankart lesion fragment is liberated, and partial fragments are osteotomized. With the anterolateral portal as the viewing portal, the anterior rim of the glenoid is now decorticated using a motorized shaver and rasp to create a bleeding bony surface. Step 2: the low rim anchor (5:30 o’clock). At the anterior-inferior aspect of the glenoid, the drill guide is positioned as low as possible (5:30 o’clock position for the right shoulder) and about 7 to 10 mm medial to the rim of the glenoid. The first 1.8 mm single-loaded suture anchor (Q-FIX All-Suture Anchor) is then inserted via the posterior portal. Step 3: the anterior-inferior-medial (AIM) anchor (4 o’clock). Step 4: the knotless high rim anchor (3 o’clock). Step 5: tying of sutures. The sutures from each anchor are tied in a mattress configuration, eventually creating a suture bridge over the labral repair Discussion/Conclusion: This dual row labral repair technique allows for maximum compression and contact between the fragment and the glenoid bed, allowing healing over a contact area rather than just the rim. The other added advantage is the use of curved tip anchors which allow negotiation of difficult corners, especially in the 5 to 6 o’clock position.

Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?

Background:Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior.Hypothesis:The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor.Study Design:Cohort study; Level of evidence, 3.Methods:This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up.Results:There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score (P = .134), the Sugaya index (P = .538), sports participation (P = .41), the radiological measurement of the Hill-Sachs lesion (P = .803), or the Rowe score (P = .182). However, there were significant differences between the groups in the Walch-Duplay score (P = .012), American Shoulder and Elbow Surgeons score (P = .005), and Filling Index Score of Remplissage grade (P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA.Conclusion:In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.

Novel technique of PCL avulsion fracture fixation using a modified double pulley method

Background: Posterior Cruciate Ligament (PCL) avulsion fractures are a rare injury and are seen to occur commonly in younger patients. Traditionally these injuries were treated conservatively and that resulted into malunion of avulsion piece and resultant PCL laxity and posterior tibial sag. This on longer run caused altered knee biomechanics, instability and early arthritis. Newer techniques are being tried in treatment in Posterior cruciate ligament avulsion fractures to prevent all these complications.Methods: We present here a surgical technique which makes use of suture anchors in a modified double pulley technique for the reduction and fixation of PCL avulsion fractures. In our institute we conducted a prospective study of 100 patients having PCL avulsion fracture in which all patients were in young age group and had a traumatic injury, less than 7 days old and followed them up at 6 weeks, 3 months, 6 months and 1 year post surgery to check for their functional and radiological outcomes. All were operated by same surgeon by same method and got the same physiotherapy protocol in same ward and come under same age group.Results: It was found that our technique showed excellent functional and radiological outcomes at 1 year follow up.Conclusions: By using this modified double pulley technique for fixation of the PCL avulsion fracture, the surgeon can achieve adequate compression and absolute stability of the fracture fragment. This method has several advantages over the other techniques used for fixation and produces equivalent or better functional and radiological outcome with very minimal complication rate.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results. Key words: Shoulder fractures; Arthroscopy; Suture anchors

Arthroscopic Remplissage Using a Double-Pulley System for Hill-Sachs Lesions for Recurrent Shoulder Instability

Hills-Sachs lesions are bony lesions in the humeral head that occur as a result of an anterior shoulder dislocation. These lesions often happen in conjunction with tears of the labrum, and large, engaging lesions must be addressed in order to avoid recurrent instability. Moderate to large (≥3 mm deep) Hill-Sachs defects can be treated using arthroscopic remplissage to reduce the rotator cuff down into the lesion. We describe in this Technical Note and accompanying video an adaptation of the classic arthroscopic remplissage that uses a knotless double-pulley technique with 2 suture anchors, which increases the footprint of fixation, reduces the technical difficulty of the procedure, and minimizes the number of portals that need to be made.

Use of a Knotless Suture Anchor to Perform Double-Pulley Capsulotenodesis of Infraspinatus

In this Technical Note, we describe an arthroscopic remplissage procedure to treat anterior instability. Specifically, we use a technique to perform double-pulley capsulotenodesis of the infraspinatus tendon using a Knotless SutureTak Suture Anchor (Arthrex, Naples, FL). This is a modification of a previously described double-pulley technique. The primary advantage of our technique compared with the previous double-pulley techniques described is that knot tying is not required.

Arthroscopic Panlabral Repair With Remplissage of Hill-Sachs Lesion

Recurrent shoulder instability in young contact athletes has been well established. The importance of bipolar bone loss in instability has come to the forefront in terms of proper management of this condition. It remains controversial, however, which patients would be better served with an arthroscopic versus open procedure and when additional procedures may reduce the risk of failure (i.e., remplissage). We present our arthroscopic technique of a panlabral repair with concomitant remplissage using the double-pulley technique. The purpose of this article is to provide insight into obtaining superior visualization while reviewing surgical pearls and pitfalls to efficiently perform a panlabral repair and remplissage.

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We present the arthroscopic remplissage technique originally described by Koo and Burkhart et al. with a modification in the percutaneous anchor placement and suture tying that is reproducible and effective. We percutaneously place 2 suture anchors, which require no additional suture passing across the tissue, to create a double pulley technique, filling the defect with posterior capsule and rotator cuff. Therefore, the Hill-Sachs defect becomes extra-articular, eliminating the potential engagement of the anterior glenoid and contribution to recurrence of instability. This technique is applicable broadly for most Hill-Sachs lesions that need addressing. By not having to pass or shuttle any suture through tissue after anchor placement and by eliminating the necessity to go subacromially to retrieve or tie suture, the technique saves time and improves reproducibility. The compression of tissue into the Hill Sachs surface area also is improved by double-reinforced suturing through the double-pulley technique. The combination of these advantages creates a sound and efficient technique for remplissage.

The Combined “Double-Pulley” Simple Knot Technique for Arthroscopic Transtendon Fixation of Partial Articular-Sided Tear of the Subscapularis Tendon

Subscapularis tendon tears occur more frequently than previously suspected. Most subscapularis tendon tears are partial tears that have the potential to progress to complete tears. Repairs of partial tears of the tendon are performed to preserve normal shoulder function. This report describes a combined transtendon double-pulley and simple knot technique for repair of partial articular tears of the subscapularis tendon. This technique incorporates the advantages of transtendon repair, the double-pulley technique, and simple knot fixation.

The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

IntroductionMajority of the current medial patellofemoral ligament (MPFL) reconstruction techniques vary with respect to methods of fixation on the patella. In an effort to maximise the area of patellar footprint coverage and minimise the complication of patellar fracture, we developed a procedure that implemented the double-pulley suture anchors technique. DesignProspective case series. SettingA primary medical centre in Kaohsiung, Taiwan. Patients and methodsEighteen consecutive patients (18 knees) who met the inclusion criteria underwent the aforementioned operation between January 2010 and March 2012. Patients were evaluated using functional scores (Kujala and Tegner–Lysholm scores), apprehension test, and radiographic examination (congruence angle and patellar tilting angle) preoperatively and at the follow-up. ResultsThe mean follow-up was 35 months. A firm endpoint to lateral patellar translation was noted in all patients at the last follow-up with a mean lateral translation quadrant of 1.5 (improved from 3.5 preoperatively, p<0.001). Both clinical and radiographic assessment improved significantly (p<0.001); the mean Kujala score improved from 55.3±6.8 preoperatively to 95.2±3.5 at the last follow-up; TegnerLysholm from 43.6±8.1 to 93.6±6.8; the mean congruence angle improved from 20.6°±2.1° preoperatively to −5.2°±2.4° at the last follow-up; and the patellar tilting angle from 23.8°±2.3° to 9.6°±1.3°. ConclusionThe double-pulley patellar fixation technique, by having a result that is comparable with those of other studies that used aperture fixation techniques, can be a promising surgical option for anatomically reconstructing the medial petellofemoral ligament.

Hybrid Repair of Large Crescent Rotator Cuff Tears Using a Modified SpeedBridge and Double-Pulley Technique

An ideal rotator cuff repair maximizes the tendon-bone interface and has adequate biomechanical strength that can withstand a high level of demand. Arthroscopic transosseous-equivalent rotator cuff repairs have become popular and have been shown to be superior to many other methods of fixation. We present an alternative method of repair for large crescent rotator cuff tears that combines 2 well-known methods of fixation: modified SpeedBridge (Arthrex, Naples, FL) and double-pulley techniques. These 2 repair constructs were combined to provide the greatest amount of compression across the footprint while also providing rigid fixation. Ultimately, this can provide an optimal environment for healing in otherwise significant injuries.