The "3 Sister Portals" for Arthroscopic Repair of Massive Rotator Cuff Tears

Arthroscopic repair of massive rotator cuff tear represents one of the most technically demanding arthroscopic procedures. To achieve a complete repair, adequate access of the torn edges of the cuff tendon is a prerequisite. Although numerous arthroscopic portals have been described by many authors, there is no ideal portal that gives access to every part of the torn rotator cuff. We describe the "3 sisterportals," consisting of the subclavian, Neviaser, and a new posterior infraspinous portal, which provide access to all parts of the cuff tendon with minimal rotation of the arm. In addition, this new portal does not require a skin incision or a cannula, and it can be located with ease even if there is extravasation of fluid into the subcutaneous tissue during the arthroscopic procedure. The direction, point of puncture, and the desired distance to be pierced from the torn cuff edge can be easily controlled with a Banana SutureLasso introduced through this portal. We have repaired more than 300 massive rotator cuff tears using these 3 sister portals without complications.