Arthroscopic surgery takes the lessons of conventional open surgery and allows these to be performed in a minimally invasive manner (White et al. 2006). Shoulder surgeons surely understand the complexity and pitfalls of arthroscopic rotator cuff repair. Starting from the initial fixation, the surgeon must construct a strong chain that consists of bone, suture material, suture configuration, and arthroscopic knot (Gerber et al. 1994) and that will withstand the loads imposed upon it during biological healing (Schneeberger et al. 2002). Moreover, in the presence of “soft” porotic bone, it is advisable to augment it so to avoid any cutout. Taking into considerations the transosseous technique to repair a rotator cuff tear, once evaluated and accurately prepared both the tendinous (size, quality, retraction, and pattern of the tear) and bony (porosis, cyst, presence of devices such as anchors employed in previous surgery) side of the lesion, the surgeon is able to plan how it is possible “to close the hole,” following what is established in the flow chart reported below (Fig. 8.1).
This is a preview of subscription content, log in to check access.
Pure transosseous technique (MP4 179233 kb)
8-shape technique (MP4 128293 kb)
2 MC technique (MP4 147683 kb)
2 C technique (MP4 154491 kb)
Baumgarten KM, Wright RW. Arthroscopic knot tying: an instruction manual. Philadelphia, PA: Lippincott Williams and Wilkins; 2005.Google Scholar
Chillemi C, Mantovani M, Osimani M, Castagna A. Arthroscopic transosseous rotator cuff repair: the eight-shape technique. Eur J Orthop Surg Traumatol. 2017;27(3):399–404.CrossRefPubMedGoogle Scholar
Gerber C, Schneeberger AG, Beck M, Schlegel U. Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br. 1994;76:371–80.CrossRefPubMedGoogle Scholar
Ryu KJ, Kim BH, Lee Y, Lee YS, Kim JH. Modified suture-bridge technique to prevent a marginal dog-ear deformity improves structural integrity after rotator cuff repair. Am J Sports Med. 2015;43(3):597–605.CrossRefPubMedGoogle Scholar
Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C. Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am. 2002;84:2152–60.CrossRefPubMedGoogle Scholar
Snyder SJ. Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture shuttle relays, and no. 2 nonabsorbable mattress sutures. Orthop Clin North Am. 1997;28(2):267–75.CrossRefPubMedGoogle Scholar
White CD, Bunker TD, Hooper RM. The strength of suture configurations in arthroscopic rotator cuff repair. Arthroscopy. 2006;22(8):837–41.CrossRefPubMedGoogle Scholar