Arthroscopic transosseous rotator cuff repair

The arthroscopic approach for rotator cuff repair is extensively used worldwide. Different repairing procedures have evolved with the aim of restoring anatomy and function of rotator cuff tendon. Several studies have analyzed biomechanical factors to understand their influence on tendon to bone healing and improve repair configurations. From a biomechanical point of view, single-row anchor techniques are not able to restore all of the original footprint of the rotator cuff, and result in circumferential tension around the tendon. Transosseus simple suture repairs may have greater potential for healing at the tendon-bone interface, because they allow a larger insertion site area and better pressure characteristics. Biomechanically, double-row suture anchor repair increases the area of contact and the initial fixation strength, decreases the load for each suture loop, knot and anchor, and decreases the stress at each suture-cuff contact point. To optimize healing, transosseous-equivalent techniques have been developed. The oblique suture bridges allow greater pressurized contact, low profile, and interconnection between fixation points that permits to shear load. Clinical studies showed equivalent clinical results of single- and double-row suture anchor repair. However, to date, there are no randomized controlled trials on transosseous or transosseous-equivalent techniques for rotator cuff repair. Clearly, studies of higher levels of evidence, including large randomized trials, should be conducted. Future trials should use validated functional and clinical outcomes, adequate methodology, and be sufficiently powered.