This is the first monograph dedicated exclusively to transosseous technology and the first book supported by the Transosseous Academy.

The book covers all of the aspects from etiopathogenesis and classification to imaging, from the rationale of supporting the use of transosseous to an extensive comparison between various repair techniques.
An historical background is covered together with an updated description of the features of the most recent arthroscopic devices used to repair the cuff using a transosseous approach. In the second half of the book, surgical indications and suggested rehabilitation protocols are provided.

In the last part, economical aspects are addressed.

The authors are well recognized in the international shoulder arena and share their extensive clinical experience about transosseous. With a forward by Prof. Gigante and Dr. S. Snyder this is a must have guide for anyone wanting to know more about and adopt what is still considered the gold standard in rotator cuff repair (RCR).

In this paper a new and original biomechanical cadaveric set up was used to simulate a revision case. Surprisingly, the performance of a transosseous repair in a revision repair demonstrated equivalence to a primary repair (also comparable to an anchor repair) and the footprint contact area was still greater than with an anchor approach. The advantage of having no hardware is important in the case of a future revision as well as limiting the invasiveness of the future repair. Revising an anchor with a transosseous approach can be very effective way because the tuberosity is left more or less unaffected leaving space for further repairs and simplifying potential future procedures. The clear message is this: Anytime a repair is accomplished, a consideration of the future and the possibility of revision is key to adopting a repair strategy

This paper presents a finite element model (FEM) capable of reproducing in an original way the repair effect.

This can represent a new frontier in predicting repair performance and in comparing different repair approaches.
Two key factors are also measured through the model: extension of the footprint contact area and stress peaks at the interface tendon suture. We know from literature, the extension of the footprint contact between tendon and bone is an indicator (more important in larger tears) of the repair performance in the long term. Another weak point to be investigated (but less known and considered) is the importance not only to extend the contact pressure area but also limit and control the stress at the interface to avoid undesired failures.

This paper is about the measurement of the gap formation as a key predictor of repair performance. The rotator cuff repair (RCR) is stressed in a dynamic way allowing the time-zero-repair to be maintained over time. Some geometrical and environmental variables are addressed in the paper affecting the efficacy of the repair. In particular, tunnel shape and bone quality are discussed as well as its influence on the repair performance as evaluated in a biomechanical lab set up.