Editorial Commentary: Anchors Away! Reflections on Anchor Placement and Number in Rotator Cuff Repair

The ideal construct for a rotator cuff repair continues to be a hot topic for debate and biomechanical investigation. A recent study shows that anchors could be placed as close as 1 mm apart without impact on pullout strength. However, further overlap (the buddy anchor construct) led to earlier failure. This conclusion differs from other studies that have recommended the "buddy anchor" construct as a bail-out option in osteoporotic bone. Biomechanical studies are an important source of information for surgical decision making, but often do not directly predict the in vivo environment. The final determination of anchor number and placement in a rotator cuff repair should be based on 4 factors: minimizing cost, avoiding complications, using appropriate technique, and proper restoration of anatomy.