Outcomes Following Usage of All Suture Anchors for Rotator Cuff Repair

Objectives: All-suture anchors are a recent addition that serve as an alternative to conventional suture anchors utilized for arthroscopic rotator cuff repair (RCR). All-suture anchors provide several benefits compared to conventional suture anchors. All-suture anchors have smaller insertion widths and require less bone removal for insertion, thus maintaining bone stability and allowing for more anchors to be used in a region where bone availability is compromised. The increased number of anchors allows for the repair load to be more evenly distributed across more fixation points, allowing increased compression of soft tissue to bone. Additionally, the variable sizes of the anchors (1-3.2 mm) and the ability to insert with curved angle guides allow for more flexibility during repair. All-suture anchors do not distort MRI, allowing the surgeon to better assess the quality of repair. Finally, the nonabsorbable material may inhibit greater tuberosity cyst formation during anchor bio-integration or resorption, as can be seen with biocomposite constructs. The purpose of this study is to investigate functional outcomes and complication rates in patients who underwent arthroscopic rotator cuff repair with all-suture medial row anchors compared to traditional suture anchors during a transosseous equivalent repair. Methods: All patients undergoing primary arthroscopic RCR from January 1 st , 2017, to January 1 st , 2023 were eligible for inclusion. Operative notes were reviewed to determine tear size, type of anchors utilized, and concomitant pathology diagnosed and treated. Patients were separated into 2 groups based on which suture anchor was used (all-suture versus traditional (screw in anchors)). Patient medical records were examined to determine postoperative range of motion (ROM) and strength. Patient-reported outcome (PRO) measures such as American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Simple Shoulder Test (SST), and Visual Analogue Pain Scale (VAS) were gathered. Results: In total, 252 patients were ultimately included for final analysis. One hundred and eighteen patients (46.8%) underwent aRCR with all-suture anchors, while 134 (53.2%) patients had aRCR with traditional suture anchors. The size of the tears was significantly larger in the all-suture cohort (18.21 ± 12.9 mm) than the traditional anchor cohort (13.93 ± 6.1 mm) (p=0.037). The number of sutures used (8.26 ± 4.3 vs. 5.0 ± 2.1) as well as the number of anchors used (2.97 ± 1.4 vs. 2.6 ± 1.3) were significantly greater in the all-suture cohort than the traditional anchor cohort (p<0.001 and p=0.018, respectively). No other demographic or operative information was significantly different between groups (p>0.05). Abduction was found to be greater in the all-suture cohort (176.2°[GD3] [GD4] ± 14.8 vs. 168° ± 18.6, p<0.001). No other ROM parameter was significantly different between groups (p>0.05). The all-suture cohort also demonstrated greater proportions of postoperative strength in the 4+/5 and 5/5 categories when compared to traditional anchor patients (p=0.015). All-suture patients reported lower (better) VAS Pain scores postoperatively (1.2 ± 1.1 vs. 2.8 ± 2.1, p<0.001). ASES, DASH, and SST scores did not differ between cohorts (p>0.05). Conclusions: Patients who undergo aRCR using all-suture medial row anchors have increased abduction and strength postoperatively, as well as lower pain scores compared to traditional suture anchors during a transosseous equivalent repair. En masse, suture anchors made entirely of suture material can be used in patients undergoing aRCR during a transosseous equivalent repair, resulting in successful clinical and functional outcomes.