Arthroscopic Knotless Double-Row Transosseous Equivalent Repair Is a Viable Option for Treatment of Large and Massive Rotator Cuff Tears

Purpose: To determine the clinical outcomes of large and massive rotator cuff tears treated with a knotless double-row transosseus equivalent repair. It is hypothesized that there would be statistically significant improvement in pain, range of motion, and function over time. Methods: Patients who had an arthroscopic rotator cuff repair (Current Procedural Terminology code 29827) performed by a single surgeon at a community-based hospital were reviewed over a 32-month period. Patients were included if their tear measured more than 3 cm in the coronal and sagittal planes based on preoperative magnetic resonance imaging and if they had a repair using a knotless transosseous equivalent technique with suture tape. Minimum follow-up was 2 years. Clinical evaluation was performed using shoulder functionality tests, Constant score, and University of California, Los Angeles score. Postoperative ultrasonography was performed and reviewed by a musculoskeletal radiologist. Data were compared preoperatively versus postoperatively using the Wilcoxon rank test. Results: Thirty-two patients met inclusion criteria with an average age of 64.4 ± 8.7 years. The average tear size on coronal magnetic resonance imaging T2 imaging was 4.0 ± 0.7 cm and on sagittal imaging was 4.2 ± 1.8 cm. The average follow-up was 2.5 ± 1.1 years. At the 2-year follow-up the average pain had improved from 7.3 to 0.8 (P < .001), the UCLA score improved from 11.6 to 31.2 (P < .001) and the Constant score improved from 38.3 to 78.7 (P < .001). At the final follow-up, the mean shoulder scaption strength was 16.1 lbs. on both the nonoperative shoulder and postoperative shoulder (P = .95). Of the 14 patients available for postoperative ultrasound, 12 showed sonographic healing (86%), 1 partial tear, and 1 full-thickness tear. Conclusions: The arthroscopic double-row transosseus equivalent repair is a viable option for repairing large and massive rotator cuff tears with significant improvement in pain, active range of motion, functional outcomes and a high rate of radiographic healing. Level of Evidence: Level IV, retrospective case series.