Transosseousequivalent

Transosseousequivalent, also known as transosseous-equivalent rotator cuff repair, is an arthroscopic technique used to repair tears of the supraspinatus and other rotator cuff tendons. It aims to reproduce the footprint coverage and healing potential of traditional transosseous repair while using suture anchors in a double-row construct. The approach creates a medial row of anchors near the articular margin and a lateral row farther laterally, generating a suture bridge that compresses the tendon onto the bone across the entire footprint.

In typical execution, medial-row sutures are passed through the torn tendon edge and secured by anchors placed at the medial footprint. The sutures are then retrieved and fixed with lateral anchors, producing a compressive, rip-stop, or mattress-like configuration that distributes load and increases contact area between tendon and bone. Variations exist, including knotted and knotless systems, and configurations designed to minimize tissue cut-through.

Indications generally include full-thickness rotator cuff tears and select large or retracted tears where a robust tendon-bone compression is desired. The technique is chosen to maximize footprint coverage and potentially improve healing by distributing forces more evenly than single-row repairs.

Advantages commonly cited include larger tendon-bone contact area, improved initial fixation strength, and avoidance of bone tunnels required by some transosseous methods. Potential drawbacks encompass hardware-related complications, higher cost, a steeper learning curve, and the possibility that outcomes depend on tendon quality and rehabilitation.

The transosseousequivalent approach emerged in the early 2000s as part of the evolution of arthroscopic rotator cuff repair, and it remains one of several double-row or suture-bridge strategies used to optimize tendon healing.