Dr. Garcia demonstrates his technique for arthroscopic rotator cuff repair.

In this video, Dr. Grant Garcia demonstrates his technique for managing a complex, layered arthroscopic rotator cuff repair. The patient initially presented with multiple pathologies, including a comprehensive SLAP (Superior Labrum Anterior to Posterior) tear that required standard debridement, and a heavily diseased long head of the biceps tendon, which was subsequently managed with an open subpectoral biceps tenodesis.

The primary focus of the operation details treating a large, U-shaped central supraspinatus tear that is delaminated (split into two distinct layers of tissue). Recent clinical data demonstrates that separately managing and repairing both layers yields much better long-term structural outcomes.

The procedure is executed through the following critical stages:

• Subacromial Decompression: Moving into the subacromial space, Dr. Garcia uses a 5.5 mm shaver and bone cutter to perform a subacromial decompression. Shaving down and flattening a prominent acromial bone spike removes structural impingement to prevent it from rubbing against and wearing down the repair post-operatively.
• Footprint Bed Preparation: A specialized cannula (Passport cannula) is positioned to hold back the deltoid muscle and optimize visualization. Using a radiofrequency (RF) wand and a shaver, Dr. Garcia clears out poor-quality, frayed tissue from the tear margins and prepares a clean, vascular bone bed on the greater tuberosity to support tendon healing. He checks tissue mobility to ensure the cuff can be tensioned without needing a graft.
• Medial Row Anchor Placement: Dr. Garcia inserts a 4.75 mm bio-composite Corkscrew anchor loaded with heavy suture tape at the posterior-medial footprint boundary, followed by a matching anchor placed anterior-medially.
• Layered Suture Passing (The Double-Pass Technique): To adequately capture the thick, delaminated tissue layers, the surgeon uses a FastPass Scorpion suture passer. Because the tissue layers are too thick to pierce in a single motion, he uses a double-pass technique—reloading the instrument to bite through the deep layer first, and then sequentially piercing the superficial layer.
• Side-to-Side and Medial Compression: The suture tapes are arranged to handle a concurrent side-to-side (margin convergence) closure and a horizontal mattress medial row repair. Tying these strands down with alternating half-hitches provides strong initial compression over the bone bed. The suture tape ensures the structural knots remain flat and low-profile, reducing the risk of subacromial friction or erosion.
• Transosseous-Equivalent Lateral Row Fixation: To create a dense, double-row construct, the remaining suture tape limbs are mapped across the footprint in a crisscross pattern. Dr. Garcia punches a pilot hole at the anterior-lateral border of the tuberosity and drives in a 4.75 mm PushLock anchor. He then gathers the remaining posterior strands and secures them into a posterior-lateral row anchor.

A final evaluation with an arthroscopic probe demonstrates a secure, high-tension, transosseous-equivalent double-row repair that completely re-approximates the anatomy. A passive shoulder range of motion check is performed at the conclusion of the surgery to confirm the overall stability of the construct under kinetic load.