Arthroscopic transosseous anchorless versus suture anchor repair for rotator cuff tears: a meta-analysis

TL;DR

This study compares two surgical techniques for rotator cuff tears and finds they have similar outcomes, with one showing better shoulder movement.

Contribution

The study provides a meta-analysis showing transosseous anchorless repair is comparable to suture anchor repair for rotator cuff tears.

Findings

TOA and AR showed no significant differences in functional scores or retear rates.

TOA improved abduction range of motion significantly compared to AR.

Subgroup analyses confirmed equivalent outcomes when comparing TOA to different anchor techniques.

Abstract

Arthroscopic transosseous anchorless repair (TOA) has re-emerged as an alternative to suture anchor repair (AR) for rotator cuff tears, offering potential biomechanical advantages and cost savings. However, comparative efficacy remains debated. This meta-analysis evaluates clinical and structural outcomes of TOA versus AR techniques.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, six databases were systematically searched until May 2025. Comparative studies reporting functional scores (Constant, ASES), range of motion (ROM), visual analog scale (VAS) pain score, and retear rates were included. Risk of bias was assessed using Cochrane RoB 2 for randomized trials and MINORS for non-randomized studies. Meta-analyses used mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI).

Eight included studies demonstrated no statistically significant differences in most outcomes. Pooled analysis revealed no statistically significant differences in functional recovery (Constant score: MD = 1.54, 95%CI: -0.08 to 3.16, P = 0.06; ASES score: MD = 1.64, 95%CI: -0.62 to 3.90, P = 0.15) or postoperative pain (VAS: MD = − 0.05, 95%CI: −0.36 to 0.26, P = 0.76). Retear rates were comparable between TOA (13.2%) and AR (15.6%) groups (RR = 0.84, 95%CI: 0.49–1.46, P = 0.55). However, TOA showed superior improvement in abduction ROM (MD = 10.51, 95%CI: 5.29–15.72, P < 0.0001), while external rotation, internal rotation, and forward flexion showed no inter-group differences. Subgroup analyses confirmed equivalent outcomes when TOA was compared specifically to double-row or single-row anchor techniques.

This meta-analysis demonstrates that TOA yields comparable clinical and structural outcomes to AR for rotator cuff tears. The only observed advantage of TOA was a statistically superior improvement in abduction range of motion. Therefore, TOA represents a viable alternative to anchor-based techniques in clinical practice.

The online version contains supplementary material available at 10.1186/s12891-026-09557-8.

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