Arthroscopic Transosseous Anchorless vs Anchored Rotator Cuff Repair: A Comparison of Clinical and Patient Reported Outcomes, Structural Integrity, and Costs

Abstract

Recent advancements in instrumentation have accommodated an arthroscopic, anchorless transosseous rotator cuff repair, which reproduces the gold standard of open transosseous repair. This study compares the clinical outcomes and cost effectiveness of anchorless, transosseous (AT) repair to the anchored transosseous, equivalent (TOE) technique. We conducted a retrospective cohort analysis of 92 arthroscopic rotator cuff repairs with minimum 1-year follow up. The experimental group included patients who underwent arthroscopic anchorless, transosseous repair. All patients had full thickness tears of the supraspinatus and/or infraspinatus tendons. We collected numeric rating scale (NRS) pain scores, range of motion, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) scores, and Simple Shoulder Test (SST) scores. Ultrasound studies were performed at 1-year postop. There were 43 patients in the control (TOE) group and 49 patients in the experimental (AT) group who met all inclusion criteria and completed a minimum 1-year follow up. Baseline demographic data for age and sex did not differ between groups. At minimum 1-year follow up, there was no difference between groups with respect to SSV (p = 0.97), VAS (p = 0.46), ASES score (p=0.59), SST score (p=0.90) or range of motion in abduction, forward elevation, and external rotation (p=0.63, 0.65, 0.42 respectively). Ultrasound studies showed no difference in rotator cuff integrity between groups at an average of 15.2 months after surgery. The TOE group had 1/21 partial retears of the rotator cuff. The AT group had 2/26 partial retears and 1 retear of the rotator cuff. Cost analysis suggested 30-80% implant savings per case for the AT group depending on tear size. Arthroscopic transosseous rotator cuff repair achieves similar clinical outcomes, patient-reported outcomes, and healing rates with 30-80% reduction in implant costs, compared to traditional anchored techniques.