Clinical and Radiological Outcomes of Rotator Cuff Repairs Using All-Suture Anchors as Medial Row Anchors

Document Type : RESEARCH PAPER


1 Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom

2 Orthopaedic and Traumatology Unit, University “Federico II” of Naples, Naples, Italy

3 The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, England

4 1 Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom- 5 Smart Health Academic Unit, University of East London, London UK

5 1 Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom 2 Fortius Clinic, London, England


Background: The aim of our study is to report the clinical and radiological outcomes of a series of prospectively
enrolled patients who have had double-row transosseous equivalent rotator cuff repairs, where all-suture anchors
were used as medial-row anchors, with a minimum follow-up of 1 year.
Methods: Twenty-two consecutive patients underwent arthroscopic transosseous equivalent double-row rotator
cuff repair using all-suture anchors as medial-row anchors. Oxford Shoulder Score, Constant Score and Visual
Analogue Scale pain score, together with shoulder range of motion, were used preoperatively and at 3 months, 6
months and final follow-up. Radiological evaluation was performed with magnetic resonance imaging at one-year
post surgery to assess the structural integrity of the repair and the rate of cyst formation in greater tuberosity.
Results: The patient mean age was 61 years (range 46-75). Minimum follow-up was 1 year, and the mean final
follow-up was 15 months (range 12-24). Healing failure in our patients was less than 5% (1/22 patients). There were
significant improvements in shoulder function outcome scores at final follow-up. The Constant and Oxford scores
were 78 and 44 at final follow-up respectively. There were similar magnitudes of improvement in range of motion
(combined abduction and rotation), pain score and supraspinatus strength at final follow up. The improvements
in outcome scores were already statistically significant at 3 months (p <.001). Using Kim’s classification for cyst
formation on T2-weighted MRI images, we observed no fluid or minimal fluid collection in 85% of the patients (17/22
patients). There were no correlations between the grade of bone changes and the clinical outcomes.
Conclusion: It is safe to use all-suture anchors as medial-row anchors when performing double-row anchor
transosseous equivalent rotator cuff repairs. The purported advantages of all-suture anchors may outweigh their
perceived disadvantages in rotator cuff repair surgery.
Level of evidence: IV


1. Narvani AA, Imam MA, Polyzois I, Sarkhel T, Gupta
R, Levy O, et al. The “pull-over” technique for all
arthroscopic rotator cuff repair with extracellular
matrix augmentation. Arthroscopy techniques. 2017;
2. Pandey. V, Willems. W.J. Rotator cuff tear: A detailed
update. Asia Pac J Sports Med Arthrosc Rehabil
Technol. 2015; 2(1): 1–14
3. Narvani AA, Consigliere P, Polyzois I, Sarkhel T, Gupta R,
Levy O. The “Pull-Over” Technique for Arthroscopic
Superior Capsular Reconstruction. Arthrosc Tech.
2016 ;5(6): e1441–e1447.
4. Consigliere P, Polyzois I, Sarkhel T, Gupta R, Levy O,
Narvani AA. Preliminary, Results of a Consecutive
Series of Large & Massive Rotator Cuff Tears Treated
with Arthroscopic Rotator Cuff Repairs Augmented
with Extracellular Matrix. Arch Bone Jt Surg. 2017
;5(1) :14‐21.
5. Denard PJ, Burkhart SS. The evolution of suture anchors
in arthroscopic rotator cuff repair. Arthroscopy.
6. Consigliere P, Salamat S, Kader N, Imam M, Gowda A,
Narvani AA. The X-Pulley. Technique for Subpectoral
Long Head of the Biceps Tenodesis Using All-Suture
Anchors. Arthrosc Tech. 2019 ;8(2): e189–e197
7. Consigliere P, Morrissey N, Imam M, Narvani AA.
The Tripod-Pulley Technique for Arthroscopic
Remplissage in Engaging Hill-Sachs Lesions. Arthrosc
Tech. 2017 ;6(5): e1675–e1684
8. Dimock RAC, Kontoghiorghe C, Consigliere P,
Salamat S, Imam MA, Narvani AA. Distal Triceps
Rupture Repair: The Triceps Pulley-Pullover
Technique. Arthrosc Tech. 2019 ;8(1): e85–e91
9. Outerbridge RE. The Etiology of Chondromalacia
Patellae. 1961. Clin Orthop Relat Res. 2001;(389) :5-8.
10. Goschka AM, Hafer JS, Reynolds KA. Biomechanical
Comparison of Traditional Anchors to All-Suture
Anchors in a Double-Row Rotator Cuff Repair
Cadaver Model Clin Boimech (Bristol, Avon).
2015;30(8) :808-13
11. Brolin TJ, Updegrove GF, Horneff JG. Classifications
in Brief : Hamada Classification of Massive Rotator
Cuff Tears. Clin Orthop Relat Res. 2017; 475(11):
12. Fuchs B, Weishaupt D, Zanetti M, Holder J, Gerber
C. Fatty degeneration of the muscles of the rotator
cuff: Assessment by computed tomography versus
magnetic resonance imaging. J Shoulder Elbow Surg
13. Cofield RH. Subscapular muscle transposition
for repair of chronic rotator cuff tears. Surgery,
gynecology & obstetrics. 1982; 154(5):667-72.
14. Narvani AA , Imam MA , Godenèche A, Calvo E,
Corbett S , Wallace AL, et al. Degenerative Rotator
Cuff Tear, Repair or Not Repair? A Review of Current
Evidence. Ann R Coll Surg Engl. 2020;102(4) :248-255
15. Kim S H, Kim D Y, Kwon J E, Park J S , Oh J H. Perianchor
Cyst Formation Around Biocomposite Biodegradable
Suture Anchors After Rotator Cuff Repair. Am J Sports
Med. 2015;43(12):2907-12
16. Sgaglione NA. Editorial Commentary: Shoulder Repair
All-Suture Fixators: Anchors Away or Tell Us Why
Not? Arthroscopy.2019.35(5):1359-61.
17. Van Den Bracht H, Van den Langenbergh T ,
Pouillon M , Verhasselt S , Verniers P, Stoffelen
D. Rotator Cuff Repair with All-Suture Anchors: A
Midterm Magnetic Resonance Imaging Evaluation of
Repair Integrity and Cyst Formation J Shoulder Elbow
Surg 2018;27(11):2006-2012.
18. Imam MA, Abdelkafy A. Out Comes following
arthroscopic transosseous equivalent suture bridge
double row rotator cuff repair: a prospective study
and short-term results SICOT J. 2016; 2:7.
19. Koh. K. H, Kang. K.C, Lim. T. K, Shon. M.S, Yoo . J.C.
Prospective Randomized Clinical Trial of Single-
Versus Double-Row Suture Anchor Repair in 2- To 4-cm
Rotator Cuff Tears: Clinical and Magnetic Resonance
Imaging Results Arthroscopy 2011;27(4):453-62.
20. Pfeiffer. FM, Smith MJ, Cook JL, Kuroki K. The
Histologic and Biomechanical Response of Two
Commercially Available Small Glenoid Anchors
for Use in Labral Repairs. J Shoulder Elbow
Surg. 2014;23(8) :1156-
21. Ro K. Peri anchor Cyst Formation After Arthroscopic
Rotator Cuff Repair Using All-Suture-Type,
Bioabsorbable-Type, and PEEK-Type Anchors.
Arthroscopy. 2019 ;35(8) :2284-92.
22. Dhinsa BS, Bhamra JS, Aramberri-Gutierrez M,
Kochhar T, Mid-term clinical outcome following
rotator cuff repair using all-suture anchors. J of clinic
orthop Trauma. 2018, p241–243
23. Hughes A, Even T, Narvani AA, Atoun E, Van Tongel
A, Sforza G, et al. Pattern and time phase of shoulder
function and power recovery after arthroscopic
rotator cuff repair. Journal of shoulder and elbow
surgery. 2012; 21(10):1299-303.
24. Visscher LE, Jeffery C, Gilmour T, Anderson L, Couzens
G. The History of Suture Anchors in Orthopaedic
Surgery. Clin Biomech (Bristol, Avon). 2019;61 :71-8
25. Kilinc AS, Ebrahimzadeh MH, Lafosse L. Subacromial
internal spacer for rotator cuff tendon repair:“the
balloon technique”. Arthroscopy: The Journal of
Arthroscopic & Related Surgery. 2009 1;25(8):921-4