Rotator Cuff Repair Technique With Transosseous Knotless Anchor System

Abstract

Various surgical techniques exist for rotator cuff repair that provide a suitable environment for tendon–bone healing. Arthroscopic recreation of transosseous repairs, which had previously been performed by open or miniopen techniques, can now be performed; however, arthroscopic, transosseous passage of suture material can be challenging technically. There are potential biologic and cost-saving advantages of arthroscopic transosseous rotator cuff repair that make an efficient and reproducible technique desirable for arthroscopists. The technique for arthroscopic transosseous rotator cuff repair using a knotless anchor-based system is demonstrated in the current Technical Note. Potential advantages of this construct include excellent biomechanics, enhanced footprint vascularization, and utility in poor bone quality while using minimal anchor numbers. Further studies will be needed to elucidate healing rates and clinical outcomes.

The Arthroscopic “Montgolfier Double-Row Knotless” Rotator Cuff Repair Technique

“…This article details a double-row suture anchor repair that may provide advantages to the surgeon over prior iterations with suture anchors (Table 2). 7, 8, 9 The suture bridge technique, for example, was developed to optimize coverage of the footprint by crossing sutures over the repaired rotator cuff 4, 7. This contrasts with the linear suture configuration of the Montgolfier double row, which remains parallel to the long axis of the rotator cuff tendon and its medial blood supply 12 .…”

“…These constructs have a high ultimate load to failure and permit maximal contact with the footprint of the greater tuberosity 5, 6. Nonetheless, anchor placement and suture configuration are reported variably in the literature, and no single technique has been shown to be superior 7, 8, 9…”

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

“…The construct aims to give a compression similar to osteosutures used in the classic open anchor-less method 223,224 . Arthroscopic bone tunnels for tendon fixation is a recent attempt at achieving the same fixation as in the open techniques 85,202 .…”

True Transosseous Hybrid Rotator Cuff Repair

“…As with many thought paradigms, rotator cuff repair methods exhibit a recursive cyclical pattern beginning with open transosseous, then progressing to mini-open transosseous, arthroscopic anchor-based techniques, and finally a return to arthroscopic transosseous 1, 2, 3, 4. Fundamentally, the literature has never shown any difference in outcomes between techniques; however, it stands to reason that the arthroscopic ease of use and biomechanical strength of anchors have fostered their adoption, contributing to the use of anchors as the current preferred repair modality.…”

“…Anchor-based constructs have introduced a new failure mode, causing truncation of the tendon, possibly as a result of modulus mismatch and stress risers at the medial anchor, tissue strangulation, or impaired vascularity. In contradistinction, transosseous repairs tend to respect vascularity in the repaired tendon and leave more tendon remnant available for revision 1, 2, 3…”