LAMINA SPECIFFIC ROTATOR CUFF REPAIR ( 5th generation)

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 Prathmesh Technique

Lamina-Specific Double-Row Repair by Dr. Prathmesh Jain

Dr. Prathmesh Jain has developed a 5th-generation, lamina-specific rotator cuff repair technique that focuses on restoring each anatomical layer of the rotator cuff individually, ensuring more anatomical, stronger, and biologically superior healing.

Traditional repairs compress the cuff as a single mass, but Dr. Jain’s method separates, mobilizes, and repairs the inner and outer lamina independently, respecting their different fiber orientations and tension patterns.

Key Principles

Anatomy-Respecting Technique
The rotator cuff has two laminae:

Inner (Deep) Lamina – Short, longitudinal, collagen-dense fibers.

Outer (Superficial) Lamina – Longer, oblique fibers contributing to footprint coverage.

Dr. Jain’s technique restores each lamina to its natural position and tension.

Differential Tensioning
Each lamina is repaired with its own tension, preventing over-compression and improving biomechanics.

Enhanced Biology
Two-layer repair increases the healing surface area and restores the native rotator cuff footprint.

Step-by-Step Surgical Technique

1. Identification & Separation of the Laminae

The inner and outer laminae are carefully identified and separated.
Motion is demonstrated to ensure that each lamina moves independently.

2. Inner Lamina Repair (Medial Row)

A medial row anchor (RootFix / standard medial row anchor) is inserted.
Sutures are passed through the inner lamina only.

3. Mason-Allen Configuration

Inner lamina sutures are tied in a Mason-Allen / rip-stop fashion, creating a strong primary fixation with excellent tissue hold.

4. Linking to Outer Lamina

After securing the inner lamina, the free suture limbs are passed through the outer lamina, without disturbing the inner repair.

5. Outer Lamina Repair (Lateral Row)

A lateral-row anchor (knotless system preferred) fixes the outer lamina, completing a true double-row, anatomically layered reconstruction.

6. Differential Tension Adjustment

The inner lamina is tightened first for deep footprint compression.
The outer lamina is tensioned later with lighter compression to preserve vascularity.

7. Final Construct

A dual-layer repair is achieved:

Strong inner repair → primary stability

Broad outer compression → footprint coverage

This mirrors the native tendon architecture better than conventional single-layer repairs.

Advantages of the Prathmesh Lamina-Specific Technique

Biomechanical

Stronger repair with dual-layer load sharing

Reduced gap formation

Superior rotational and translational control

Better tension matching to native tendon

Biological

Larger healing surface area

Reduced strangulation of outer tissues

Better perfusion

More anatomical footprint reconstruction

Clinical

Lower re-tear rates

Improved function and pain relief

Faster rehab because of strong initial fixation

Especially useful in:

High-grade partial tears

Large and massive tears

Delaminated tears

Revision cuff repair

Summary

The Prathmesh Technique of Lamina-Specific Rotator Cuff Repair is a 5th-generation, next-level rotator cuff reconstruction method that focuses on anatomical fidelity, biomechanical strength, and optimized biology.
By repairing each lamina separately, Dr. Jain achieves a reconstruction that is far closer to the natural tendon structure, offering superior functional outcomes.