Original Research Arthroscopic Rotator Cuff Repair Using the Undersurface Technique A 2-Year Comparative Study in 257 Patients

Background: Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty. Purpose: To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n 100) or undersurface (n 165) of the supraspinatus tendon. Data were collected pre-operatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using stan-dardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair. Results: At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P <.001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21 % for bursal side, 23 % for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursa