Rotator cuff tears are a common cause of shoulder pain and discomfort. Arthroscopy has evolved into the preferred surgical technique for treatment of rotator cuff tears; however, controversy remains regarding the best anchor configuration and suture technique. Debate exists on whether or not to tie the medial row in a double row transosseous equivalent cuff repair. While biomechanical differences of these techniques have been determined, no clinical studies have shown an advantage of tying the medial row versus not tying the medial row for repair. The purpose of this study is to retrospectively investigate the clinical findings and outcomes of patients who underwent knotted medial row rotator cuff repair (KT-RCR) compared to patients who underwent knotless medial row rotator cuff repair (KL-RCR).
A retrospective chart review of 189 patients who had double-row RCR in 2016 was performed at a single institution with 2-year follow-up. Information regarding demographics, preoperative (magnetic resonance imaging), surgical variables including method of suture stabilization, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rates of cuff failure (determined by MRI), and all complications (e.g., infection, adhesive capsulitis, surrounding soft tissue injury) were compiled.
There were 72 patients in the KL-RCR group versus 117 in the KT-RCR group. There was a significant difference in age (55.1 vs 59.1; p=0.002) and in the percentage of patients that underwent RCR on their dominant arm (47.7% vs. 66.7%; p=0.020) in the KL-RCR vs KT-RCR groups respectively. However, there were no significant differences between groups in regards to gender (31.9% female vs 29.9 % female; p=0.895) or side of surgery [45.8% right vs 60.7% right; p=0.065). As determined by MRI grading, there were significantly fewer preoperative small-medium tears (36.8% vs 56.4%; p=0.013) and greater large-massive tears (63.2% vs 43.6%; p=0.013) in the KL-RCR versus KT-RCR groups respectively. There was no significant difference in preoperative ASES scores (48.3 vs 45.4 respectively; p=0.327) between groups. Average follow up time for each group was similar (39.3 months KL-RCR vs 33.5 months KT-RCR; p = 0.057). There was a significant difference in the number of anchors used (3.21 vs. 2.27; p=0.001) between the KL-RCR and KT-RCR groups. Postoperative ASES scores (82.4 vs. 78.8; p=0.579) did not differ between the KL-RCR and KT-RCR groups. There was no significant difference in terms of rates of cuff failure after 2 years, determined by MRI, (5.6% vs 6.1% KL-RCR vs KT RCR; p=1.000) or rates of all complications (11.1% vs 8.6% KL-RCR vs KT RCR; p=0.743).
Our results support the conclusion that pursuing either a knotted or knotless approach to a double-row rotator cuff repair leads to similar outcome scores, rates of cuff failure, and all complications at the two-year period.