Arthroscopic rotator cuff repair using a transhumeral approach to fixation

A new technique for arthroscopic rotator cuff repair using arthroscopically placed transhumeral sutures is presented. After an adequate acromioplasty is performed, a modified anterior cruciate ligament tibial drill guide is used to drill two or more transhumeral holes from the metaphyseal-diaphyseal junction of the humerus to the greater tuberosity. Sutures are then passed into these holes and through the rotator cuff using cannulated needles. The sutures are tied manually and the repair is inspected. The postoperative protocol is presented. The new technique may be superior to the current methods for arthroscopic rotator cuff repair in that (1) the strength of fixation does not rely on the quality of the bone in the greater tuberosity of the humeral head (which can be quite poor) as suture anchor techniques do, (2) the sutures are easily passed through the rotator cuff without relying on complicated suture passing techniques, (3) the knots are tied without the aide of an arthroscopic knot-tying device, and (4) in cadaveric studies, the failure strength of this new repair was equal to the strength of a traditional open repair. Prospective studies are ongoing to assess the efficacy of this new technique.