Evaluating transosseous anchorless repair for arthroscopic rotator cuff surgery: a comparative study with double row anchor repair

Background: This retrospective observational study aimed to compare the outcomes of arthroscopic rotator cuff surgery using double row anchor repair (DRR) versus transosseous anchorless repair (TAR) in patients with small to large full-thickness rotator cuff tears.Methods: A total of 42 patients underwent either DRR (n=20) or TAR (n=22) between January 2022 and May 2023. Patients were matched based on age, sex, body mass index, and tear severity to ensure comparability. Baseline demographics, including age, sex distribution, diabetes mellitus, smoking status, and Cofield full-thickness tear classification, were compared between the two groups. Functional outcomes were assessed using the University of California, Los Angeles and American Shoulder and Elbow Surgeons scores, as well as range of motion (ROM) parameters including forward flexion (FF), extension (EXT), internal rotation (IR), external rotation (ER), and abduction (AB). Independent t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, with a significance level set at P<0.05.Results: The two groups showed similar baseline characteristics with no significant differences in age, sex distribution, smoking status, or tear classification (P>0.05 for all). At 3- and 6-month post-surgery, TAR demonstrated significantly higher ULCA scores compared to DRR (3 month: TAR, 23.82 vs. DRR, 22.30, P<0.001; 6 month: TAR, 8.18 vs. DRR, 26.60, P<0.001). Similarly, TAR showed superior ASES scores at 3 months (TAR, 67.55 vs. DRR, 64.49; P=0.025) and 6 months (TAR, 95.33 vs. DRR, 91.48; P<0.001). However, these differences had decreased by the 1-year follow-up, at which time there were no significant disparities in ULCA (TAR, 28.95 vs. DRR, 28.40; P=0.101) or ASES scores (TAR, 96.19 vs. DRR, 95.09; P=0.051). There were no statistically significant differences in ROM parameters between the groups at the 1-year follow-up (P>0.05 for FF, EXT, IR, ER, AB).Conclusion: The DRR and TAR techniques resulted in comparable outcomes regarding baseline characteristics and 1-year functional recovery in patients undergoing arthroscopic rotator cuff repair for medium to large tears. TAR showed early advantages in functional scores at 3- and 6-months post-surgery, suggesting potential benefits in the initial recovery phase. These findings can aid the practitioner in selecting appropriate surgical techniques based on individual patient needs and expectations.Level of evidence: III.