Background: Since 2006, we have performed arthroscopic Surface-holding procedure, which is a modified transosseous-equivalent procedure, for rotator cuff tear. The objective of this study was to evaluate clinical results and postoperative cuff integrity of this procedure.
Methods: One-hundred and three shoulders were included in this study. There were 63 men and 40 women, and the average age at surgery was 64.5 years old (range: 43-86). There were 1 incomplete, 10 small, 50 medium, 22 large, and 20 massive tears. At surgery, the footprint was medially advanced. The threads of medial anchors were passed through the tendon and, without tying, were pulled out to the distal cortex of the greater tuberosity. JOA score and cuff integrity on MRI using Sugaya's classification were evaluated. The average follow-up period was 16.7 months (range: 12-40).
Results: The average postoperative JOA score was 92.5 points (66-100) in total, 94.7 points in small/medium tears, and 89.2 points in large/massive tears. The re-tear rate was 11.6% in total; 8.3% in small/medium tears and 16.7% in large/massive tears. Excellent or good score was obtained in 94% of well-repaired shoulders; whereas it was 50% in re-tear shoulders.
Discussion: Arthroscopic Surface-holding procedure has several advantages: medial advancement of footprint to decrease tension to the repair site, no knot tying on the surface of cuff tendon to prevent re-tear at medial site, no usage of lateral anchors to avoid backout of an anchor in osteoporotic bone, and a wide contact area. As a result, low re-tear rate was observed especially in large and massive tears.
