A Novel Transosseous Button Technique for Rotator Cuff Repair

In an attempt to maximize stability by improving the lateral footprint compression of our repair in rotator cuff tears, we have been using a rotator cuff button (Arthrex, Naples, FL) passed through a transosseous tunnel as an anchor for our transosseous sutures. Our new innovation is to pass a rotator cuff button fully loaded with 4 strands around the central post, with 2 leading strands and 2 trailing strands on either end, through our transosseous tunnel. In this way, we can use the 4 central strands through our tunnel to obtain 2 good mattress sutures as a primary repair and the peripheral 4 strands passed around the lateral humerus as over sew mattress sutures to obtain good compression of the lateral tendon and so improve the footprint area. A double row equivalent is achieved. This technique has a good primary hold in the form of a device with proven history and avoids multiple anchors in the lateral humerus. Because it uses only a single fixation device, it is also significantly more economical. Theoretical risks to the axillary nerve or with osteoporosis have not been seen in practice. Tensioning the repair with suture passage through transosseous tunnels is readily achieved.