title: Comparison of implant cost and surgical time in arthroscopic transosseous and transosseous equivalent rotator cuff repair.
abstract: BACKGROUND
  We investigated the cost savings associated with arthroscopic transosseous (anchorless) double-row rotator cuff repair compared with double-row anchored (transosseous-equivalent [TOE]) repair.
  
  
  METHODS
  All patients undergoing double-row arthroscopic rotator cuff repair from 2009 to 2012 by a single surgeon were eligible for inclusion. The study included 2 consecutive series of patients undergoing anchorless or TOE repair. Excluded from the study were revision repairs, subscapularis repairs, patients with poor tendon quality or excursion requiring medialized repair, and partial repairs. Rotator cuff implant costs (paid by the institution) and surgical times were compared between the 2 groups, controlling for rotator cuff tear size and additional procedures performed.
  
  
  RESULTS
  The study included 344 patients, 178 with TOE repairs and 166 with anchorless repairs. Average implant cost for TOE repairs was $1014.10 ($813.00 for small, $946.67 for medium, $1104.56 for large, and $1507.29 for massive tears). This was significantly more expensive compared with anchorless repairs, which averaged $678.05 ($659.75 for small, $671.39 for medium, $695.55 for large, and $716.00 for massive tears). Average total operative time in TOE and anchorless groups was not significantly different (99 vs. 98 minutes). There was larger (although not statistically significant) case time variation in the TOE group.
  
  
  CONCLUSIONS
  Compared with TOE repair, anchorless rotator cuff repair provides substantial implant-related cost savings, with no significant differences in surgical time for medium and large rotator cuff tears. Case time for TOE repair varied more with extremes in tear size.
authors.affiliation: Department of Orthopaedic Surgery, Summit Medical Group, Berkeley Heights, NJ, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Black
authors.affiliation: The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Luke S
authors.initials: LS
authors.lastname: Austin
authors.affiliation: The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: Narzikul
authors.affiliation: The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Seidl
authors.affiliation: Department of Orthopaedic Surgery, Mid-Atlantic Permanente Medical Group, Largo, MD, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Martens
authors.affiliation: The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: mark.lazarus@rothmaninstitute.com.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lazarus
mesh_terms: D001182:Arthroscopy / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries / Q000191:economics* / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D014481:United States
keywords: Arthroscopic transosseous; cost; operative time; rotator cuff; transosseous equivalent; value