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.

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; = .70) or age (64.6 ± 7.2 vs 64.8 ± 7.3 years; = .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; = .39), SSV score (92.4 ± 8.9 vs 90.1 ± 13.0; = .79), or ASES score (90.8 ± 9.7 vs 92.6 ± 12.0; = .15). No differences were identified for postoperative active forward flexion (STS vs TOE: 154.2° ± 13.3° vs 159.4° ± 11.3°; = .10), external rotation (53.3° ± 6.2° vs 51.4° ± 8.7°; = .47), or internal rotation ( = .69) score. Although there were larger anteroposterior tear sizes in the STS group (21.4 ± 9.3 vs 16.0 ± 6.7 for TOE; = .04), there was no significant group difference in failure rates (11% [STS] vs 8% [TOE]; > .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.