Arthroscopic Rotator Cuff Repair Using the Undersurface Technique: A 2-Year Comparative Study in 257 Patients

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Arthroscopic Techniques

Background:

• Traditional arthroscopic rotator cuff repair occurs in the subacromial space (bursal side).
• Undersurface rotator cuff repair utilizes the glenohumeral joint, visualizing the tendon from its underside without bursectomy or acromioplasty.

Purpose of the Study:

• To compare clinical and structural outcomes of undersurface rotator cuff repair versus bursal-side repair.
• Evaluate patient-reported pain, functional ability, and repair integrity.

Main Methods:

• Retrospective analysis of prospectively collected data from two cohorts: bursal-side repair (n=100) and undersurface repair (n=165).
• Used knotless suture anchors with single-row, inverted mattress sutures.
• Assessed outcomes using the modified L'Insalata questionnaire, clinical examinations, and ultrasound at multiple postoperative time points up to 2 years.

Main Results:

• Both techniques significantly reduced pain and improved overhead activity function at 2 years (P < .001).
• No significant difference in overhead activity performance or retear rates (21% bursal, 23% undersurface) at 2 years.
• Undersurface repair had a significantly shorter mean operative time (20 minutes) compared to bursal-side repair (32 minutes) (P < .001).

Conclusions:

• Arthroscopic rotator cuff repair, from either the subacromial space or glenohumeral joint, effectively decreases pain and improves function at 2 years.
• The primary difference lies in operative time, with undersurface repair being significantly faster.
• Both techniques demonstrate comparable clinical and structural outcomes at the 2-year follow-up.