Advances in Rotator Cuff Repair-Undersurface Repair

Methods for arthroscopically repairing a torn supraspinatus tendon have improved. Suture anchors have facilitated the attachment of torn tendons to bone, and technological advances have facilitated suture placement in tendon and anchors that do not require knots to be tied. We have developed a technique to repair a torn supraspinatus tendon using inverted mattress sutures, placed in a "tension-band" configuration, whereby landing site preparation, suture and anchor placement are all made from beneath the supraspinatus, that is, visualized from within the glenohumeral joint, rather than the subacromial space. We have found that this technique is faster (the procedure on average takes 15 min), and patients have less frequent pain with overhead activities at 6 weeks and 3 months than the same technique performed from the bursal side. The failure to heal/retear rate is similar to the same tension-band repair performed from the bursal side (20%), which is better than our previous arthroscopic knotted (25%) and open double row (40%) techniques.