This technical note introduces the arthroscopic transosseous-equivalent (suture-bridge) rotator cuff repair. It reproduces the mechanics of an open transosseous tunnel repair without drilling actual bone tunnels. Medial mattress sutures are bridged over the footprint and fixed distal-lateral to the tuberosity to compress the tendon against bone.
This paper defines the suture-bridge concept that underlies modern transosseous-equivalent cuff repair. The core idea: healing depends on footprint contact area and compressive pressure, so bridging medial sutures distal-lateral to the tuberosity presses the tendon flat onto bone and restores more contact than a double-row construct.
Practical pearls worth memorizing: pass the medial sutures 10 to 12 mm medial to the tear edge, and keep lateral fixation off the top of the roughly 12-mm footprint so bone stays exposed for healing.
Use the tear-size algorithm to scale fixation. Small tears (<25%) need only withstand about 75 N of the 302 N maximal supraspinatus force, so a single row suffices. Larger tears involving most of the footprint demand the 4-suture-bridge for load-to-failure. Remember this is a technical note citing the authors' own in-press biomechanical work. In-vivo healing superiority was not yet proven here.
This technical note introduces the arthroscopic transosseous-equivalent (suture-bridge) rotator cuff repair. It reproduces the mechanics of an open transosseous tunnel repair without drilling actual bone tunnels. Medial mattress sutures are bridged over the footprint and fixed distal-lateral to the tuberosity to compress the tendon against bone.
This paper defines the suture-bridge concept that underlies modern transosseous-equivalent cuff repair. The core idea: healing depends on footprint contact area and compressive pressure, so bridging medial sutures distal-lateral to the tuberosity presses the tendon flat onto bone and restores more contact than a double-row construct.
Practical pearls worth memorizing: pass the medial sutures 10 to 12 mm medial to the tear edge, and keep lateral fixation off the top of the roughly 12-mm footprint so bone stays exposed for healing.
Use the tear-size algorithm to scale fixation. Small tears (<25%) need only withstand about 75 N of the 302 N maximal supraspinatus force, so a single row suffices. Larger tears involving most of the footprint demand the 4-suture-bridge for load-to-failure. Remember this is a technical note citing the authors' own in-press biomechanical work. In-vivo healing superiority was not yet proven here.