Arthroscopic Rotator Cuff Repair—Traditional Anchor Techniques

Initial fixation strength and minimal gap formation are thought to be important concepts for optimization of rotator cuff tendon healing. Failure of rotator cuff healing after repair has been reported to be relatively high. This suggests that traditional repair techniques fail to restore a sufficient healing environment. Traditional arthroscopic rotator cuff repairs are performed using a single row of suture anchors along the greater tuberosity. Anatomically, there is theoretical benefit of double-row repairs because techniques that increase the surface area between the tendon and bone will potentially have higher rates of structural healing. There have been significant advances in arthroscopic techniques and instrumentation for the past decade. Suture anchor design, insertion technique, and configuration are important biomechanical factors and are the subjects of recent studies. Clinical studies have failed to show superior functional outcomes or healing rates when comparing single- with double-row techniques, and there are some concerns about vascularity of the tendon using some of these double-row techniques. This article reviews the biomechanical basis of rotator cuff tear and repair, and surgical technique of rotator cuff repair, outcome of arthroscopic rotator cuff repair, and important considerations in rotator cuff repair, including tear pattern recognition, marginal convergence, and suture technique.