Dr Lebolt presents his surgical technique in Triple-Row Rotator Cuff Repair - a technique he has used in over 2,000 cases to increase the strength of the repair by adding another point of fixation.
Pulling suture over to the lateral row anchors could put stress on the medial row anchors which may cause a gap to form between the cuff and the anchor.
A more effective restoration of the anatomic footprint may be achieved by adding an independent point of fixation laterally before tying the medial knots.
Placing this central row fixation first could take some stress off the medial row anchors to help reduce the amount of space between the cuff and the anchor. It may also allow for better visualization when tying the medial knots.