A Novel Arthroscopic Transosseous Procedure for Rotator Cuff Repair: An Economical Freehand Method

ABSTRACT: Open transosseous repair was historically considered the gold-standard surgical solution for rotator cuff tears; however, with advancements in arthroscopic surgery, this procedure was largely replaced by anchor-based techniques. Yet, the ability of anchor-based techniques to achieve similar biomechanical fixation remains uncertain. In this article, we describe a reproducible, economical, arthroscopic anchorless transosseous rotator cuff repair technique that uses an Omega configuration. This technique involves two bone tunnels and four high-strength polyethylene sutures and is suitable for medium-to-large rotator cuff tears that would alternatively need multiple anchors. This procedure not only maximizes the tendon-footprint contact area without using any implanted device but also theoretically lowers the bone laceration rate and is cost effective. In the current Technical Note, the procedure is described in detail along with several tips and tricks.

Classifications

Level I, shoulder; Level II, rotator cuff. Technique Video Video 1 The arthroscope is first inserted to the joint for simple intra-articular inspection and management. Then, the scope is shifted to the subacromial space to perform bursectomy and acromioplasty before the repair begin. The cuff edge is examined and trimmed to a smooth crescent shape to ease traction suture application and manipulation of the cuff. The tuberosity spur is removed, and decortication is done at the footprint area where we planned to create the bone tunnels. A 1.5-mm straight punch is used to create the anterior pilot hole. Then, a no. 5 Ethibond suture needle is introduced into the pilot hole and slowly inserted further by using a curved needle holder, which is inserted through the lateral portal, and finally piercing the lateral humeral cortex. The scope is then moved to the subdeltoid space to seek the needle tip, which is then retrieved through the lateral portal. The posterior tunnel is created with the same manner. The suture can now be used for shuttling of the cuff sutures. The whole configuration is made from four polyethylene cuff sutures. They are attached to the proximal portion of the torn cuff by tissue penetrator. The inferior limbs are brought to the lateral row through bone tunnels via the shuttle sutures, which were previously placed within the tunnels. The medial row is tightened and tied first at the inferior limb of the anterior cortex, and then the cross-link sutures, and lastly, the traction limbs. Completion of the tying knots results in the final construct of the omega-shaped configuration.

SUBMITTER: Wu T 

PROVIDER: S-EPMC8626631 | biostudies-literature |

REPOSITORIES: biostudies-literature