Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial.
BACKGROUND
Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic.


OBJECTIVE
To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair.


METHODS
Randomized controlled trial; Level of evidence, 1.


METHODS
Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories.


RESULTS
Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81).


CONCLUSIONS
No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.|Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Pietro
P
Randelli
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Carlo Alberto
CA
Stoppani
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Carlo
C
Zaolino
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Alessandra
A
Menon
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Filippo
F
Randelli
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.|Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Paolo
P
Cabitza
D000328:Adult; D000368:Aged; D001178:Arthroplasty; D001182:Arthroscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D026741:Physical Therapy Modalities; D011184:Postoperative Period; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D020069:Shoulder Pain / Q000601:surgery; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
MRI evaluation; anchor repair; retear rate; rotator cuff; transosseous arthroscopic repair