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Background <p>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.</p> Methods <p>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).</p> Results <p>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, <i>P</i> = 0.06; ASES score: MD = 1.64, 95%CI: -0.62 to 3.90, <i>P</i> = 0.15) or postoperative pain (VAS: MD = − 0.05, 95%CI: −0.36 to 0.26, <i>P</i> = 0.76). Retear rates were comparable between TOA (13.2%) and AR (15.6%) groups (RR = 0.84, 95%CI: 0.49–1.46, <i>P</i> = 0.55). However, TOA showed superior improvement in abduction ROM (MD = 10.51, 95%CI: 5.29–15.72, <i>P</i> &lt; 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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Yuyan Na,
  • Xi Ren,
  • Zongbo Wang,
  • Yuting Shi,
  • Jingjuan Wang,
  • Litian Zhang,
  • Yizhong Ren

摘要

Background

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.

Methods

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).

Results

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.

Conclusion

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.