More recently, newer techniques for all arthroscopic transosseous repairs of the rotator cuff have been developed. These techniques utilize a custom device (ArthroTunneler, Tornier Inc, Edina, Minnesota) that enters perpendicular to the rotator cuff footprint and then exits at a nearly 90° angle toward the lateral wall of the greater tuberosity, creating a more sharply angled transosseous tunnel with potentially increased bone bridge length. Potential advantages of arthroscopic transosseous repairs include the associated decreased cost, elimination of suture anchors, and a similar ability to recreate the rotator cuff footprint. Potential disadvantages include increased surgical complexity, risk of fracture of the greater tuberosity, and suture cutout through bone, which is a known limitation of traditional open transosseous repairs.
What are the Differences in Rotator Cuff Repair Techniques?
To our knowledge, there have not been any published reports comparing the differences in initial biomechanical performance between these techniques. The purpose of this study was to evaluate the differences in initial biomechanical performance including ultimate load to failure and localized elongation with cyclic loading between transosseous-equivalent repair with suture anchors (TOE), anchorless designs of the traditional transosseous repair with curved bone tunnels (TO), and the arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX). The hypothesis was that TOE suture anchor repair would demonstrate superior initial biomechanical performance in comparison to the transosseous repair techniques.