Hrvoje Klobučar

Letter to the editor: Advantages of arthroscopic transosseous suture repair of the rotator cuff without the use of anchors.

To the editor, We read the article by Kuroda et al. [3] with great interest. In the current study, the authors describe a novel arthroscopic transosseous technique without the use of anchors. While we congratulate Kuroda and colleagues for an interesting concept and results, we believe it is necessary to emphasize several points. Matis and colleagues [4] previously described their transsoseus arthroscopical technique without the use of anchors, and Cicak et al. [1] described the technique with the use of anchors, but in transosseous manner. Following the publication of these studies, manufacturers developed a significant number of specially designed devices for arthroscopis transsoseus rotator cuff repair [2, 5]. Those techniques, which are based on the basic principle of transosseous fixation, have different limitations. Kuroda et al. [3] reported that the technique cannot be used in shoulders where the stump of the torn rotator cuff does not emerge across the top of the humeral head under traction. Also, operative time is rather long, ranging from 80 minutes to 176 minutes. This likely will increase the cost of treatment, becoming more expensive than the price of anchors. This technique also is not suitable for women with osteoporosis, it increases the risk for pullout of the sutures. Finally, we believe this technique is only suitable for experienced shoulder surgeons because it is rather complex and time consuming; in particular, it is difficult to penetrate through the skin behind the AC joint with K-wires, especially in the lateral decubitus position. Most of the described limitations (except when there is osteoporotic bone) can be avoided with other techniques even when they are based on same biomechanical principle [1, 2, 4, 5].