[Arthroscopic Transosseous Rotator Cuff Repair: First Experience]

PURPOSE OF THE STUDY To present the technique, learning curve, complications, postoperative pain levels and cost-effectiveness analysis of 24 patients with symptomatic rotator cuff tear operated with Drillbone Tunneler - a novel transosseous suture-passing device designed for arthroscopic use. MATERIAL AND METHODS Between February and May 2021, 24 patients underwent arthroscopic transosseous rotator cuff repair. During the study, the time spent preparing the tunnels was recorded along with the occurrence of complications during the operation. Price calculation of the delivered transosseous cuff repair and an alternative procedure with suture anchors was made. During the postoperative period, the patients rated their pain (on the VAS scale) twice a day, in the morning and in the evening, for 4 weeks, based on which the average values per each week were calculated. RESULTS The average time it took to prepare the tunnels and pull through the sutures was 6.2 minutes. In one case it was impossible to pull the shuttle loop through and that is why during the surgery arthroscopic transosseous-equivalent repair using suture anchors was performed instead. Apart from this, no other complications occurred. The patients reported rapid reduction of postoperative pain during the second and third week after surgery. The cost price analysis proved an average saving of CZK 9.463 per procedure. DISCUSSION There is a growing body of evidence that arthroscopic transosseous rotator cuff repairs achieve equivalent clinical outcomes as suture anchor repairs or even better clinical outcomes. These techniques are safe and effective; there is an earlier reduction of postoperative pain. Healing is more biological due to better vascularity, larger footprint coverage and clinically optimal biomechanical strength. Moreover, these techniques significantly save costs and meet requirements of the upcoming era of value-based surgery. CONCLUSIONS In our cohort, a favourable learning curve and minimum occurrence of complications were established. The study confirmed the data published so far on early relief of postoperative pain. We also proved that significant saving of costs of the materials used was achieved. Key words: arthroscopic transosseous rotator cuff repair, suture anchor, postoperative pain, cost-benefit analysis, Drillbone Tunneler.