Transtendon Technique Research Articles

Arthroscopic “Mini-Incision” Transtendon Repair of Shoulder Partial Articular-Sided Supraspinatus Tendon Avulsion

Currently, the treatment of PASTA (partial articular-sided supraspinatus tendon avulsion) lesions includes arthroscopic transtendon and completion repair, but the shortcomings of both surgical techniques are obvious. We present a modified transtendon technique combining the transtendon with the mini-completion repair that is able to minimize the trauma from anchor implantation and add more intra-articular working access using a “mini-incision” on the supraspinatus tendon.

Transtendon technique versus repair after completion of the tear for articular-sided partial rotator cuff tear: a meta-analysis of comparative studies

BackgroundTranstendon repair and repair after completion of the tear have been widely used to treat partial-thickness rotator cuff tears (PT-RCTs). The present study was aimed to compare the clinical outcomes and tendon integrity following arthroscopic repair of articular PT-RCTs using transtendon repair or repair after completion of the tear.MethodsWe performed a systematic electronic database search on Cochrane Central Register of Controlled Trials, PubMed and Embase to identify articles equating articular-sided PT-RCTs repair. The randomized controlled clinical trials that met our criteria were evaluated for quality of methodology. The results obtained were further analyzed and correlated to present the benefits and drawbacks comparing the two surgical procedures.ResultAccording to our inclusion and exclusion criteria, six articles were included in the present study. A total of 501 patients were analyzed as part of this study. The results indicated that both the surgical treatments provided excellent functional improvements and tendon integrity. However, no significant differences for the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, range of motion, postoperative adhesive capsulitis, tendon integrity and patient satisfaction were found between the two cohorts (p > 0.05).ConclusionsBoth transtendon technique and repair after completion of the tear for articular-sided partial rotator cuff tear provide improvements in clinical outcome with a low complication rate and a high rate of healing.

Comparative Clinical Evaluation of Two Techniques of Arthroscopic Treatment of Partial Articular Rotator Cuff Tears.

Objectives To evaluate the clinical results of patients submitted to arthroscopic treatment of partial lesion of the articular part of the rotator cuff by transtendon suture techniques and after completing the lesion and to compare the postoperative recovery time of the two techniques. Method Retrospective study based on the identification of all cases with partial lesion of the articular part of the rotator cuff submitted to arthroscopic treatment from October 1999 to December 2016 at the Shoulder and Elbow Group of our institution. Thirty-nine patients were included and divided into two groups: those who underwent the transtendon technique and those in whom the lesion was completed. The two groups were statistically similar. The respective medical records were analyzed as well as the identification of the applied technique, the postoperative results, and the related complications. The functional evaluation was performed using the score of the University of California at Los Angeles (UCLA). Results There was no statistically relevant difference between the groups, with a mean UCLA score of 32, and no difference in the time required for rehabilitation. Conclusion There was no difference between the clinical outcome of the patients, regardless of the technique used to repair the partial lesions of the articular part of the rotator cuff, with satisfactory results in 93% of the cases.

Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study.

The purpose of this prospective study was to compare the clinical and structural findings following the arthroscopic repair of partial-thickness (exceeding 50%) articular-sided rotator cuff tears using either a single-row or a double-row suture bridge fixation. Fifty patients were included in this study. The patients were randomly placed into two groups: 25 underwent the single-row (Group I) and 25 a double-row suture bridge fixation (Group II). The clinical outcomes were assessed using ASES and Constant shoulder scores, both preoperatively and at the end of follow-up. The pain level was evaluated using the visual analogue scale (VAS), preoperatively, at 6months and at the end of follow-up. All patients underwent preoperative MRI to identify the rotator cuff tear, and postoperatively at 12months to evaluate tendon integrity. The average follow-up was 32.5months. The mean ASES scores increased from 35.9 to 96.7 in Group I and from 35.3 to 93.4 in Group II; the mean Constant shoulder scores increased from 55.6 to 97.8 in Group I and from 57.5 to 97.3 in Group II. There were no significant differences between the two groups. The average preoperative pain level decreased from 7.4 to 3 at 6months and to 0.4 at the end of the Group I; and from 7.6 to 3 at 6months and 0.8 in Group II. There was no significant difference between the two groups. At 12months, the MRI assessments showed two retears in Group I (8%) and one retear in Group II (4%). Arthroscopic repair of partial-thickness articular rotator cuff tears that exceed 50% of tendon thickness with a single-row transtendon repair or double-row suture bridge provides functional improvement and pain relief regardless of the repair technique used. There were no differences in clinical results between both techniques. Level II; prospective comparative study.

Patient-determined outcomes after arthroscopic rotator cuff repair with and without biceps tenodesis utilizing the PITT technique

The percutaneous intra-articular transtendon technique (PITT) is a simple, rapid, and low-cost method of performing a biceps tenodesis. Few studies exist that examine the patient-determined outcomes of this technique in general or in patients undergoing arthroscopic rotator cuff repair (RCR) with and without biceps tenodesis. We hypothesized that patients undergoing an isolated arthroscopic RCR would have equivalent outcomes to those undergoing RCRs with PITT biceps tenodesis. We compared preoperative, patient-determined outcomes scores on patients undergoing primary arthroscopic RCR with and without a PITT biceps tenodesis with postoperative scores at a minimum of 2 years. These scores included the Western Ontario Rotator Cuff score (WORC), American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and Shoulder Activity Level (SAL). Indication for a concomitant biceps tenodesis was a partial long head biceps tendon tear or biceps instability/subluxation. A total of 153 patients underwent an isolated RCRand 131 patients underwent RCR with biceps tenodesis (RCRBT). Both groups had improvements in WORC, ASES, SANE, and SST (P < .0001) and deteriorations in the SAL (P ≤ .005). There was no difference in the change in outcome scores between the groups (RCRBT vs. RCR, respectively) for WORC (46 vs. 47; P = .85), ASES (46 vs. 47; P = .82), SANE (53 vs. 51; P = .35), SST (5.8 vs. 5.8; P = .93), and SAL (-0.9 vs. -1.4; P=.46). There was no difference between the groups in complications that required revision surgery (1.5% vs. 1.3%; P= .91). Arthroscopic PITT RCRBT is safe and effective with equivalent patient-determined outcomes compared with patients undergoing RCR without biceps tenodesis.

Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears.

Background:Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears.Hypothesis/Purpose:The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated.Results:Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test.Conclusion:The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear-A Meta-Analysis.

Articular surface partial-thickness rotator cuff tears (PTRCTs) are commonly repaired using two different surgical techniques: transtendon repair or repair after completion of the tear. Although a number of studies have demonstrated excellent clinical outcomes, it is unclear which technique may provide superior clinical outcomes and tendon healing. The purpose was to evaluate and compare the clinical outcomes following arthroscopic repair of articular surface PTRCT using a transtendon technique or completion of the tear. A systematic review of the literature was performed following PRISMA guidelines and checklist. The objective outcome measures evaluated in this study were the Constant Score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, physical examination, and complications. Three studies met our criteria. All were prospective randomized comparative studies with level II evidence and published from 2012 to 2013. A total of 182 shoulders (mean age 53.7 years; mean follow-up 40.5 months) were analyzed as part of this study. Both procedures provided excellent clinical outcomes with no significant difference in Constant Score and other measures between the procedures. Both procedures demonstrated improved clinical outcomes. However, there were no significant differences between each technique. Further studies are required to determine the long-term outcome of each technique.

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

The frequency of partial rotator cuff tears is gradually increasing because of the advancements in imaging methods and arthroscopy techniques. One of the repair techniques is repair of the partial rotator cuff tear by conversion to a full-thickness tear. Another technique, the transtendon technique, has some practical challenges and risks. We attempted to develop a practical and easy technique with low morbidity to repair partial tears called the rotator cerclage technique.

Which is the best repair of articular-sided rotator cuff tears: a meta-analysis.

BackgroundTear conversion followed by repair and trans-tendon techniques have been widely used for partial-thickness rotator cuff tears. Both of them showed favorable results with regard to the management of articular-sided partial-thickness rotator cuff tears (PTRCTs) of more than 50 % thickness. However, controversy continues with the best management. This study aims to compare the clinical outcomes between the two techniques.MethodsThe PubMed, Embase, and Cochrane library databases were searched for relevant studies published before October 1, 2014. Studies that clearly reported a comparison between the two procedures were selected. The American Shoulder and Elbow Surgeons scale (ASES) and the re-tear rate were evaluated. Statistical analysis was performed using the special meta-analysis software called “Comprehensive Meta Analysis”.ResultsFinal meta-analysis after the full-text review included four studies about tear conversion followed by repair and seven studies about trans-tendon technique. The trans-tendon technique showed no significant difference with the tear conversion followed by repair technique with regard to the ASES scale (P = 0.69). But the re-tear rate (P < 0.05) was markedly lower in the trans-tendon technique group than the tear conversion and repair technique group.ConclusionIn conclusion, the meta-analysis suggests that the trans-tendon technique is better than the tear conversion followed by repair technique with regard to the management of articular-sided PTRCTs of more than 50 % thickness in the re-tear rate aspect.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-015-0224-6) contains supplementary material, which is available to authorized users.

Rotator cuff tears: An evidence based approach.

Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

Arthroscopic repair of a significant (>50%) partial-thickness subscapularis tear concomitant with a full-thickness supraspinatus tear: technical considerations for subscapularis repair (transtendon technique versus tear completion)

The purpose of this study was to compare clinical outcomes and structural integrity of arthroscopic repair by either transtendon repair or tear completion for a significant (>50%) partial-thickness articular-side subscapularis tear associated with a full-thickness supraspinatus tear. The study population comprised 109 patients who underwent arthroscopic repair for partial-thickness subscapularis tears associated with full-thickness supraspinatus tears with either a transtendon technique (81 patients, group T) or tear completion (28 patients, group C). Pain on a visual analog scale; the Subjective Shoulder Value; the American Shoulder and Elbow Surgeons score; and the University of California, Los Angeles shoulder score were used to compare clinical outcomes between the 2 groups. At 6 months after surgery, magnetic resonance arthrography or computed tomographic arthrography was performed to assess structural integrity. At the 2-year follow-up, there were no significant differences in functional outcomes between groups. In group T, external rotation was reduced significantly from 55° to 51° (P < .001). The subscapularis and overall retear rates were 8% and 19%, respectively, in group T and 12% and 23%, respectively, in group C. There were no significant differences in retear rates between groups. Arthroscopic repair of partial-thickness subscapularis tears associated with full-thickness supraspinatus tears using either the transtendon technique or tear completion resulted in significant functional improvements in both groups except for postoperative external rotation in group T, and there were no significant differences between groups. The retear rates were also not significantly different between groups. However, after subscapularis repair using the transtendon technique, some patients may have decreased external rotation.

Outcome analysis of arthroscopic treatment of partial thickness rotator cuff tears.

Background:Partial thickness rotator cuff tears occupy an important position in the spectrum of rotator cuff disease. The development of a more comprehensive classification has been sought to address both the tear location and extent, which may influence clinical results. The purpose of this study is to classify partial thickness rotator cuff tears according to the arthroscopic findings and to evaluate the clinical outcomes after arthroscopic repair of partial thickness tears.Materials and Methods:One hundred and two patients had arthroscopic treatment of partial thickness rotator cuff tears. The inclusion criterion for the study was a partially torn supraspinatus tendon involving articular or bursal side, verified by direct arthroscopic visualization. Outcome analysis was exclusively applied to patients who underwent transtendon repair, using the shoulder index of American Shoulder and Elbow Society and the University of California Los Angeles (UCLA) rating system.Results:Partial thickness rotator cuff tears were divided into five groups according to arthroscopic findings. There was significant improvement after surgery in all parameters of clinical evaluation in the tears that warranted repair. Arthroscopic repair in situ (transtendon technique) may be the preferred option in unstable partial thickness tear.Conclusion:The proposed classification system may assist decision making in the treatment of partial thickness rotator cuff tears.

Biomechanical Study Comparing Biceps Wedge Tenodesis With Other Proximal Long Head of the Biceps Tenodesis Techniques

The purpose of this biomechanical study was to compare the ultimate failure strength, stiffness, cyclic displacement, and failure displacement of 5 different proximal biceps tenodesis fixation techniques, specifically comparing wedge tenodesis with the other 4 techniques. Forty cadaveric shoulders underwent 1 of 5 long head of the biceps tenodesis techniques and were cyclically tested to failure by use of tensile forces applied parallel to the longitudinal axis of the humerus. A preload at 5 N was applied for 2 minutes, followed by cyclical loading for 500 cycles from 5 to 70 N at 1 Hz and a pull-to-failure test at 1 mm/s. The techniques studied were wedge tenodesis, suture anchor fixation, suprapectoral interference screw fixation, T-wedge tenodesis, and the percutaneous intra-articular transtendon (PITT) technique. Cyclic displacement, failure displacement, and stiffness were calculated. The wedge tenodesis technique had an ultimate failure load similar to interference screw fixation and a greater ultimate failure load and stiffness than the suture anchor, PITT, and T-wedge techniques (P < .05). In this biomechanical study, wedge tenodesis was found to have an ultimate failure load similar to interference screw fixation and a greater ultimate failure load and stiffness than the suture anchor, PITT, and T-wedge techniques. On biomechanical testing, wedge tenodesis compares favorably with other techniques and may be a useful clinical option for proximal biceps tenodesis.

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

To compare two groups of patients who underwent two different arthroscopic procedures for repair of articular-sided partial-thickness rotator cuff tears (PTRCTs). This is a comparative prospective study of two methods for repair of partial cuff tears: Thirty-two patients underwent arthroscopic rotator cuff repair with a transtendon technique (group 1); 28 underwent arthroscopic full-thickness conversion and repair of the lesion (group 2). ROM measures, clinical findings, MRI features (tendon healing and re-tear), Constant-Murley and ASES scores were assessed pre- and postoperatively and compared. Patients were also asked about return to sport and level of activity. At the last appointment, patients of both the groups were significantly improved for clinical findings, ROM measures, imaging features, Constant-Murley and ASES scores than at baseline, without any significant inter-group difference. In group 1, 15 of 20 patients (75 %) who practiced recreational sport activities had returned to sport at the same level as before the onset of symptoms, without any discomfort. In group 2, 12 of 18 patients (67 %) had returned to the same level of sport activity they practiced before symptoms. At the last follow up, MRI showed rotator cuff healing in 31 patients of Group 1 and 27 patients of Group 2 (p = 0.83). The two procedures are safe, effective, and comparable.

A Prospective Randomized Clinical Study Comparing Two Repair Techniques for Partial-Thickness Articular Sided Rotator Cuff Tears (SS-13)

A Prospective Randomized Clinical Study Comparing Two Repair Techniques for Partial-Thickness Articular Sided Rotator Cuff Tears (SS-13)

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.

A Comparison of 2 Repair Techniques for Partial-Thickness Articular-Sided Rotator Cuff Tears

This prospective randomized study compared the clinical outcomes of patients who underwent partial-thickness articular-sided rotator cuff repairs by 2 surgical techniques. Forty-eight patients with a symptomatic partial-thickness articular-sided rotator cuff tear exceeding 50% of the tendon thickness were randomly assigned to 2 groups at the time of operation. Of the patients, 24 received arthroscopic rotator cuff repair with a transtendon technique (group I) and 24 received arthroscopic rotator cuff repairs after tear completion (group II). Pain intensity and patient satisfaction were assessed by visual analog scales, and functional outcomes were evaluated by use of American Shoulder and Elbow Surgeons and Constant shoulder scores. Tendon integrity was evaluated by magnetic resonance imaging at 6 months after surgery. Clinical outcomes were significantly improved after repair in both groups at a mean of 31 months' follow-up. In each group 22 patients (92%) were satisfied with surgery. However, shoulder function and range of shoulder motion recovered faster in group II during the recovery period (American Shoulder and Elbow Surgeons score, 54.9 ± 3.7 in group I v 64.6 ± 3.2 in group II; P = .037) (Constant score, 57.9 ± 2.9 in group I v 70.8 ± 3.3 in group II; P = .019). Furthermore, patients in group I had significantly more pain (5.9 ± 0.4) than patients in group II (2.8 ± 0.5) (P = .001) until 3 months after surgery. Postoperative adhesive capsulitis developed in 3 patients in group I and in 2 patients in group II. According to postoperative 6-month magnetic resonance imaging assessments, all patients in group I achieved complete integrity whereas a retear developed in 2 patients in group II. Arthroscopic repair of partial-thickness articular-sided rotator cuff tears exceeding 50% of the tendon thickness provided satisfactory functional improvements and pain relief regardless of the repair technique. Although repair after conversion to a full-thickness tear showed less postoperative morbidity, tendon integrity is of primary concern after repair. On the other hand, the transtendon repair technique resulted in complete tendon integrity but slower functional recovery. Level II, prospective comparative study.

Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results

Partial articular surface of the rotator cuff tendon tears has been recognized as a source of treatable shoulder pain and a precursory pathology for full-thickness tendon tears. Arthroscopic rotator cuff repair is a possible surgical method of treatment. Recent data have shown that the treating partial-thickness rotator cuff repairs with transtendon technique shows good clinical outcome. The use of this technique enables the reconstitution of the tendon with complete reconstruction of its footprint without damaging its intact bursal part. In cases of high grade partial articular-sided degenerative rotator cuff tears (involving >50% of the tendon) in older patients, there is a possibility of poor healing or re-tear of the rotator cuff repair, which may be associated with poor tendon quality and substantial thinning of the rotator cuff, subsequently revision surgery in these patients will be demanding. To mitigate these problems, we describe here a new arthroscopic transtendon repair technique with tenotomized long head biceps tendon augmentation for high grade partial articular rotator cuff tear with the goal of providing increase tendon healing, as well as to minimize the probability of failure of the construct and to improve the clinical outcomes. The clinical results of the first 39 consecutive patients are reported showing significant decrease in pain and improved shoulder scores, as well as the post-operative range of motion and with no cases of re-tear of the rotator cuff tendon.

Medial-Row Failure After Arthroscopic Double-Row Rotator Cuff Repair

We report 4 cases of medial-row failure after double-row arthroscopic rotator cuff repair (ARCR) without arthroscopic subacromial decompression (ASAD), in which there was pullout of mattress sutures of the medial row and knots were caught between the cuff and the greater tuberosity. Between October 2006 and January 2008, 49 patients underwent double-row ARCR. During this period, ASAD was not performed with ARCR. Revision arthroscopy was performed in 8 patients because of ongoing symptoms after the index operation. In 4 of 8 patients the medial rotator cuff failed; the tendon appeared to be avulsed at the medial row, and there were exposed knots on the bony surface of the rotator cuff footprint. It appeared that the knots were caught between the cuff and the greater tuberosity. Three retear cuffs were revised with the arthroscopic transtendon technique, and one was revised with a single-row technique after completing the tear. ASAD was performed in all patients. Three of the four patients showed improvement of symptoms and returned to their preinjury occupation. Impingement of pullout knots may be a source of pain after double-row rotator cuff repair.

Clinical follow up study of arthroscopic treatment of rotator cuff tear with concomitant biceps long head lesion

Objective To evaluate the clinical and functional outcomes in a cohort of rotator cuff tear patients who underwent arthroscopic rotator cuff repair combined with biceps tenodesis using percutaneous intra-articular transtendon technique (PITT). Methods Thirty patients with rotator cuff tear who had concomitant biceps pathology or instability were treated between March 2006 and March 2008 with arthroscopic rotor cuff repair and biceps tenodesis using PITT technique. American Shoulder and Elbow Surgeons' score (ASES), Constant-Murley score and Visual Analog scale pain score were adopted for postoperative shoulder function evaluations. The cosmetic appearance and biceps strength were also evaluated. Results Postoperative follow up period was 23 months on average (range 12 to 37 months). ASES of the 30 shoulders was 43.8 preoperatively and 94.7 postoperatively. Constant-Murley score was 52.8 and 94.1 respectively. VAS score was 5.5 preoperatively and 0.6 postoperatively. The pre-and post-operative differences of the three scores were all statistically significant ( P < 0.01). None of the 30 patients had Popeye deformity and biceps spasm at final follow up. No significant biceps strength difference was found between the operated side and the contralateral side. Twenty-nine patients were satisfied with the functional outcome. Conclusion PITT is a safe and reliable treatment option for biceps pathology in rotator cuff tear patients. Shoulder pain relief and biceps strength maintenance can be well expected without any cosmetic deformity. Key words: Shoulder joint; Arthroscopes; Follow-up studies; Rotator cuff tears