Background:Because current instrumentation makes it possible to perform an arthroscopic transosseous rotator cuff repair, we performed a biomechanical comparison of a double-row transosseous equivalent rotator cuff repair using suture anchors to an arthroscopic, transosseous rotator cuff repair to determine if they provided similar fixation stability. Methods:Six pairs of shoulders were used. One of each pair had a standard double row, transosseous equivalent arthroscopic rotator cuff repair using a suture-bridge technique with suture anchors, and the other had an arthroscopic transosseous repair using an Xbox technique. The repairs were cycled at 150 N for 10,000 cycles with movement of the lateral cuff edge recorded and then tested to failure. Results:The total cuff edge displacement at 10,000 cycles in the anchor group (transosseous equivalent repair) was 7.9 mm and 6.3 mm for the bone tunnel group (transosseous repair); these were not significantly different (p = 0.19). The anchor group failed at an average of 309 N and the bone tunnel group at an average of 339 N (p = 0.22). Discussion:Biomechanical testing suggests that arthroscopic, transosseous rotator cuff repair using a Xbox suture configuration is similar in strength and stability to an arthroscopic transosseous equivalent suture-bridge repair. Both techniques demonstrated difficulty in maintaining the lateral position of the tendon.