Repair of rotator cuff injuries using transosseous tunnels. Introduction to the technique, devices and other relevant points.

Rotator cuff injuries are common and procedures of repair have evolved from open techniques to minimally invasive and arthroscopic ones. Despite these advances, the biomechanics, biology, and value of transosseous repairs remain superior, leading to the development of innovative devices that enable the utilization of this technique without the use of anchors, improving both the efficiency and safety of the procedure. This article reviews the latest advances in transosseous rotator cuff repair, highlighting its biomechanical advantages, as well as the factors that enhance recovery and offer more consistent long-term outcomes. In addition, the surgical technique developed by Dr. Brett Sanders is analyzed. This technique eliminates or reduces the use of anchors with a specialized reusable device, depending on the clinical scenario and surgeon discretion. Besides, not only presents biomechanical benefits but also offers economic and clinical advantages, especially in developing countries where access to advanced treatments may be limited. Comparative studies between transosseous and transosseous-equivalent techniques have demonstrated a significant reduction in postoperative pain and statistically equivalent or superior long-term clinical outcomes with the arthroscopic transosseous tunnel technique (ATOT), reinforcing its viability as a superior option for value-based care. Finally, a detailed economic analysis is presented, showing significant cost savings in surgical procedures which could greatly benefit public healthcare systems in Latin America, highlighting advanced suture management that would enhance rotator cuff repair.