Arthroscopic Transosseous Rotator Cuff Repair.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Open transosseous rotator cuff repair (RCR) was the historical standard.
• Arthroscopic surgery and suture anchors became prevalent, offering advancements but incurring significant costs and potential complications.
• The high cost and challenges associated with suture anchors have prompted a re-evaluation of surgical techniques.

Purpose of the Study:

• To review the historical, biomechanical, clinical, and economic literature on arthroscopic transosseous RCR.
• To evaluate the feasibility and benefits of returning to transosseous techniques in arthroscopic rotator cuff repair.
• To compare arthroscopic transosseous RCR with suture anchor techniques.

Main Methods:

• Literature review of historical RCR techniques.
• Analysis of biomechanical studies comparing transosseous tunnels and suture anchors.
• Review of clinical outcomes and complication rates for both methods.
• Economic analysis of suture anchor costs versus transosseous tunnel creation.

Main Results:

• Transosseous tunnels were the original benchmark for RCR before the advent of arthroscopy.
• Suture anchors, while advancing arthroscopic capabilities, are expensive and can lead to complications.
• Arthroscopic techniques utilizing transosseous bone tunnels eliminate the need for costly suture anchors.
• Emerging evidence suggests arthroscopic transosseous RCR is a viable and potentially more economical alternative.

Conclusions:

• Arthroscopic transosseous RCR represents a return to a foundational technique, adapted for modern arthroscopic surgery.
• This approach mitigates the economic burden and potential complications associated with suture anchor technology.
• Further research into the long-term biomechanical and clinical efficacy of arthroscopic transosseous RCR is warranted.