In arthroscopic rotator cuff repair, poor tendon quality, medially based tears, lateral tendon loss, or limited tendon mobility can all preclude the use of double-row suture constructs, presenting a challenge in achieving secure fixation and tendon-to-bone healing. Rip-stop suture configurations can be used in these settings to improve resistance to tissue cutout and provide enhanced biomechanical characteristics compared with standard single-row repairs. The load-sharing rip-stop technique uses 2 double-loaded medial suture anchors, which are placed adjacent to the articular margin, and 1 rip-stop suture tape, which is independently secured to bone with 2 lateral knotless anchors. The load-sharing rip-stop technique has been shown to improve ultimate load to failure by 1.7 times compared with a single-row repair. Clinically, this technique has been associated with a 53% healing rate of large and massive rotator cuff tears, compared with only 11% healing when using single-row repair. A completely knotless variation rip-stop configuration also has been described and shown to be biomechanically equivalent to a single-row repair with triple-loaded anchors. For surgeons desiring a single-row repair only, the knotless rip-stop therefore presents an advantage by eliminating the need for knot-tying and decreasing operative time.
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