Arthroscopic Repair With Side-to-Side Sutures for Full-Thickness Transtendinous Supraspinatus Tears Versus Traditional Tendon to Bone Fixation: Outcomes and Retear Rates at 4-Year Follow-up

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Background: Full-thickness, transtendinous supraspinatus rotator cuff tears involve a significant portion of the remanent tendon attached to the footprint. Purpose: To compare outcomes and failure rates for arthroscopic side-to-side (STS) suture repair for transtendinous tears versus traditional double-row repair for common tendon-to-bone type tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort of 18 patients with full-thickness transtendinous supraspinatus tears who underwent STS suture repair was compared with a group of 36 matched controls with classic tendon avulsion who underwent double-row knotless transosseous-equivalent (TOE) repair. All patients had ≥2 years of follow-up. Demographics, postoperative active range of motion, and patient-reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, and Subjective Shoulder Value (SSV), were collected. Results: There were no significant differences between the STS and TOE groups regarding mean follow-up (48.2 ± 18.5 vs 47.9 ± 20.5 months; P = .70) or age (64.6 ± 7.2 vs 64.8 ± 7.3 years; P = .79). With respect to clinical outcomes and PROs, there were no differences in postoperative VAS pain score (STS vs TOE: 0.94 ± 1.5 vs 0.89 ± 1.8; P = .39), SSV score (92.4 ± 8.9 vs 90.1 ± 13.0; P = .79), or ASES score (90.8 ± 9.7 vs 92.6 ± 12.0; P = .15). No differences were identified for postoperative active forward flexion (STS vs TOE: 154.2° ± 13.3° vs 159.4° ± 11.3°; P = .10), external rotation (53.3° ± 6.2° vs 51.4° ± 8.7°; P = .47), or internal rotation ( P = .69) score. Although there were larger anteroposterior tear sizes in the STS group (21.4 ± 9.3 vs 16.0 ± 6.7 for TOE; P = .04), there was no significant group difference in failure rates (11% [STS] vs 8% [TOE]; P > .99). Conclusion: Arthroscopic STS suture repair for transtendinous supraspinatus tears yielded excellent outcomes with low failure rates, comparable with tendon-to-bone double-suture anchor repair for typical tendon avulsion–type cuff tears. Retention of the large tendon stump on the greater tuberosity with STS repair also allows restoration of anatomy without undue tension in this uncommon scenario.

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