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5th Generation Rotator Cuff Repair by Dr. Prathmesh Jain

A Lamina-Specific Double-Row Repair Technique with Differential Tension

Rotator cuff repair surgery has evolved through several generations—from open single-row constructs to sophisticated double-row and trans-osseous equivalent repairs. Taking this evolution further, Dr. Prathmesh Jain, Director of Advance Hospitals, Ahmedabad, has pioneered the 5th Generation Lamina-Specific Rotator Cuff Repair Technique, which introduces a paradigm shift in understanding and restoring rotator cuff anatomy.

Concept

The rotator cuff tendon consists of two distinct structural laminae—an inner (articular) lamina and an outer (bursal) lamina. Conventional repairs often compress both layers under uniform tension, leading to non-anatomic healing and variable load sharing.
Dr. Jain’s approach precisely identifies, mobilizes, and repairs each lamina separately, respecting their differential tension and biomechanical orientation.

Technique

Inner Lamina Repair:
The articular-side fibers are first reattached to the medial footprint using medial-row anchors, restoring the inner tension band in a mason allen fashion

Outer Lamina Repair:
The lateral (bursal) lamina is then secured independently using lateral-row anchors, employing the same sutures from the inner lamina to create a true lamina-to-lamina linkage rather than a simple tendon compression.

Differential Tensioning:
Each lamina is tensioned according to its native elasticity and orientation, ensuring anatomical footprint restoration, better load distribution, and improved biological healing.

Advantages

Restores true anatomical laminar structure

Allows differential tension between inner and outer layers

Reduces over-compression and tissue strangulation

Improves tendon-bone contact and vascularity

Enhances long-term repair integrity and function

This innovation positions Dr. Prathmesh Jain’s Lamina-Specific Double-Row Technique as a 5th-generation advancement in the evolution of rotator cuff surgery—bridging the gap between biomechanical sophistication and biological healing.