The Tendon-to-Bone Seam: A Transtendinous Approach to Rotator Cuff Repair

This technique article describes the tendon-to-bone seam technique, a knotless, transtendinous approach to arthroscopic rotator cuff repair. The technique employs a single-use deployment device preloaded with multiple PEEK anchors interconnected with a single polyethylene #2 suture, enabling the surgeon to create a continuous "seam" of independent fixation points along the rotator cuff footprint. By alternating arm position rather than portal placement, the surgeon can often access the entire footprint for repair through the standard anterolateral arthroscopic portal. The tendon-to-bone seam technique allows for medial and lateral row configurations without knot tying or complex suture management. The accompanying illustrations and video show the key steps and principles of this technique, which aims to simplify arthroscopic repair, enhance footprint coverage, and potentially reduce tendon stress by spreading contact forces across the entire footprint.