Arthroscopic Undersurface Rotator Cuff Repair

Our standard method to repair a torn rotator cuff usually involved an arthroscopic evaluation of the glenohumeral joint, then placing the arthroscope in the subacromial space, debridement of the torn edges of the tendon, and the landing site and reattachment of the torn tendon to the bone with suture anchors. We modified our technique so that these steps were performed while the arthroscope remained in the glenohumeral joint. Thus the repair was visualized from the undersurface rather than the bursal side of the rotator cuff. The aim of this study is to describe the "undersurface'' technique and evaluate its effect on operative time, postoperative pain and function, and cuff integrity. The operative time, patient-determined outcomes, and ultrasound determined cuff integrity of 2 cohorts of consecutive patients who had a rotator cuff tear repaired arthroscopically with a knotless system (Opus Magnum, ArthroCare Corporation, Sydney, Australia) either through the standard bursal side approach (bursal repair; n = 60) or undersurface repair; (n = 50), were compared. The groups were matched for age (mean 60 y for both groups) and tear size (2.8 cm2 vs. 2.9 cm2; P = 0.81). Those patients who had a combined undersurface and bursal repair, those who had other significant shoulder pathologies or surgeries, or were unable to complete 6 months follow- up were excluded. The average operative time for the bursal repair group was 48 minutes and for the undersurface repair was 16 minutes (P< 0.001). Patients in the undersurface group showed earlier reduction in the frequency of pain during activity and less difficulty with reaching behind the back at 6 months (30% less difficult, P = 0.011). Ultrasonographic retear rate at 6 months (bursal 15%; undersurface 20%) was similar (P = 0.7). The undersurface approach to arthroscopic rotator cuff repair was on average more than three times faster than the conventional bursal side approach, and resulted in similar retear rate but more superior clinical outcomes in the first 6 months after repair.