Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

Abstract

Background:Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty.Purpose:To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair.Results:At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001).Conclusion:Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of pain and difficulty with overhead activities at 2 years. The major difference between the 2 techniques was operative time, with the undersurface technique being performed significantly faster than the bursal-side repair technique.

A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases

“…Previous studies have shown that undersurface repairs were, on average, between 12 and 32 minutes faster to perform than bursal-sided repairs when the same suture anchors were used. 23,29 The difference in operative time is most likely because there is no need to perform a bursectomy or acromioplasty. Furthermore, performing an acromioplasty and/or bursectomy may induce bleeding, which can impair visualization of the torn tendon and other structures within the glenohumeral joint.…”

“…Furthermore, performing an acromioplasty and/or bursectomy may induce bleeding, which can impair visualization of the torn tendon and other structures within the glenohumeral joint. 23,29…”

“…12 Reported mean operative times for arthroscopic rotator cuff repair techniques range from 32 to 113 minutes. 6,23,27,29 Longer operating times are associated with higher economic costs and potentially adverse clinical outcomes; they may also be associated with infection and thromboembolic complications 29 and, as suggested by a number of studies, possible increased risk of retear. 13,27 However, the incidence of thromboembolic complications is low in arthroscopic rotator cuff repair surgery.…”

“…2 Preliminary results in small cohorts of patients with this technique were promising, with a markedly reduced operative time as compared with the bursal-sided technique and with a similar retear rate. 23,27,29 However, we were unsure how this technique would hold up, with particular respect to the retear rate, in a large cohort of patients.…”

Are we getting any better? A study on repair integrity in 1600 consecutive arthroscopic rotator cuff repairs

“…Before repair debridement of the torn tendon and anatomical footprint was completed using an arthroscopic shaver. The tear was repaired using either a bursal or an undersurface approach as outlined by Rubenis et al 31 . Sutures were passed through the torn tendon using the Opus Smart Stitch device (ArthroCare Corp, Sydney, Australia).…”