Single-row suture repair combined with tension-reducing augmentation versus double-row suture bridge repair for medium-to-large u-shaped supraspinatus tears: a retrospective cohort study with 2-year follow-up

A U-shaped tear of the supraspinatus tendon is a common subtype of medium‑to‑large rotator cuff tears in clinical practice. Double‑row suture bridge (DRS‑B) repair is widely used for such tears and yields favorable clinical outcomes, while DRS‑B is associated with greater surgical complexity and potential complications.Single-row suture with transosseous lateral reinforcement(SRS‑TR) represents an emerging alternative designed to simplify fixation. The present study was performed to compare SRS‑TR with DRS‑B for the treatment of medium‑to‑large U‑shaped tears of the supraspinatus tendon. A retrospective cohort study was conducted on medium-to-large (maximal width: 2–5 cm) U-shaped supraspinatus tears patients who were randomly selected to fix with either the SRS-TRor the DRS-B between January 2020 and January 2025. The primary endpoints and evaluation indicators included intraoperative anchor usage, acromiohumeral distance (AHD), length of hospital stay, follow-up duration, postoperative shoulder range of motion (ROM), visual analogue scale (VAS) for pain, UCLA Shoulder Rating Scale score, American Shoulder and Elbow Surgeons (ASES) score, patient-reported surgical satisfaction, tendon integrity, and retear rate. The SRS-TR group exhibited significantly shorter operative time (mean difference: −49.6 min, P = 0.033), lower anchor usage (mean: 3 vs. 4 anchors, P < 0.001), and a reduced incidence of intraoperative anchor revision (0% vs. 13.3%, P = 0.038) compared with the DRS-B group. AHD was significantly greater in the SRS-TR group both at 3 days postoperatively (mean: 9.91 mm vs. 7.12 mm, P = 0.022) and at final follow-up (mean: 11.81 mm vs. 9.12 mm, P = 0.043). No postoperative complications were observed in either group. There were no statistically significant differences on length of hospital stay, follow-up duration, ROM, VAS, UCLA, ASES, patient-reported surgical satisfaction, and retear rate. At a mean follow-up of 23.1 months, both groups achieved comparable functional outcomes in patients with medium-to-large U-shaped supraspinatus tears. However, SRS-TR conferred significant procedural advantages—including shorter operative time, reduced anchor burden, lower intraoperative anchor revision rates, and superior maintenance of AHD. These findings support SRS-TR may yield comparable or superior outcomes at intermediate-term follow-up for the treatment of medium-to-large U-shaped supraspinatus tendon tears. Level III, comparative study.