Two Techniques for Treating Medium-Sized Supraspinatus Tears

Arthroscopic rotator cuff repair emerged in the early 1990s, and the single-row repair technique (i.e., suture anchor[s] set at the center or laterally on the greater tuberosity) has shown promising outcomes; however, the healing rate of the repaired cuff is suboptimal. Although small to medium-sized rotator cuff tears have shown better clinical outcomes and structural healing than larger tears, healing failure still occurs 1 .There are several factors that affect rotator cuff healing. The initial stiffness and strength of the repair, gap formation resistance, footprint coverage at the end of surgery, vascularity of the cuff, and mechanical stress on the repaired cuff are important factors 2 . To improve tendon-to-bone healing, 2 repair techniques have been developed: the suture bridge technique and the medially based single-row technique. The suture bridge technique involves placing anchors in a 2-row fashion, with medial-row sutures from the medial anchors bridged over the footprint with lateral-row knotless anchors 3 . The single-bridge technique has shown biomechanical superiority in terms of ultimate strength, stiffness, and gap formation resistance 4 ; however, these outcomes are achieved at the cost of relatively high tension at the suture-cuff junction, as well as interference with vascularity at the medial mattress sutures if medial mattress sutures are tied.Alternatively, the medially based single-row technique was proposed as a modification of the laterally based (traditional) single-row technique 5 . This technique is combined with the creation of bone marrow vents (microfracture technique) lateral to the inserted anchor in the footprint to promote soft-tissue regeneration (called "neotendon") over the exposed footprint. The theoretical advantages of this technique include lower tension on the repaired cuff; better screw purchase beneath the subchondral bone, which avoids weaker cancellous bone on the peripheral area of the greater tuberosity; and avoidance or reduction of lateral shift of the muscle-tendon junction. However, these outcomes are achieved with relatively weaker initial fixation strength and by exposing the uncovered greater tuberosity footprint lateral to the repaired tendon edge.Both procedures provide equivalent outcomes as measured by functional and pain scores. At present, there is no decisive superiority in treating small to medium-sized supraspinatus tears.