Introduction: Reconstruction of the original footprint of the supraspinatus tendon is mandatory in achieving proper clinical result after reconstrucitve rotator cuff surgery.

Methods: Twenty four cadaveric sheep shoulder and 12 live sheep sacrificed 3 months after rotator cuff reconstruction were tested. Arthroscopic transosseous technique and double row techniques were compared according to static load immediately after reconstruction (sheep cadaver) and after tissue healing took place (in vivo on sheep). In clinical work we analysed results of 120 patients operated on by the senior author employing different arthroscopic Methods: of rotator cuff reconstructionas.

Results: Transosseous technique and double row technique have comparable biomechanical primary ultimate load to failure (160 N and 137 N comparatively) and equal ultimate load to failure after the tissue heals (302 N and 246 N respectively). Immediately after the reconstruction in double row group we noticed significant fragility in comparison to elasticity of the tendon-bone complex in transosseous group. We operated 67 shoulders (56%) with arthroscopic transosseous technique. We did not noticed complications of bone anchor, but in two patients we had rerupture of sutures that had to be reoperated on.

Discussion: Arthroscopic transosseous technique uses less amount of bone anchors, optimaly reconstructs “footprint”, and has equal ultimate static load to failure as double row technique. But, double row technique is much more fragile than transosseous method in immediate postoperative period. Arthroscopic transosseous technique is technicaly demanding procedure that guarantee optimal clinical result.