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lifestyles. • Anchor systems. Improvements in bony fixation let surgeons repair tendons back to the bone using anchors that are easier to place and provide good pull-out strength. The newer anchor systems are comprised of bioabsorbable material attached to metal tips, which surgeons can tap into tough bone. The streamlined process means surgeons are able to place anchors in essentially any location, meaning they can place access portals in locations to attack joints at optimal angles. Some controversy sur- rounds the use of bioabsorbable anchor material based on beliefs that it may cause bony absorption or splits in bone, but I haven't experi- enced those adverse events. The other benefit of bioabsorbable anchors is that if they were to dislodge, they'd absorb into tissue on their own. • Specialized suture. Suture that's a little wider than traditional options and reinforced with a Gore-Tex-like material makes tendon fixation extremely strong. It also spreads the tension across a larger surface area on the tendon to enhance overall healing of the rotator cuff foot- print. Newer sutures also allow for knotless repair, which involves placing a suture around the labrum or the rotator cuff, then fixing it with an anchor that essentially sucks the suture into the bone. That creates secure, knotless fixation and avoids knot "towers" from forming in the joint. The towers can cause irritation and pain at the joint, and can irritate cartilage. Knotless suturing also removes a technically demanding component of arthroscopic procedures that adds several minutes to cases. My rotator cuff repairs are 30 minutes shorter because I don't have to tie sutures. • Improved imaging. High-definition cameras and monitors have greatly enhanced the potential of arthroscopic surgery, because now surgeons can see details they never saw before, which helps to pinpoint pathology and confirm that the repair is optimal without guessing about the quality 1 0 5 M A R C H 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T