Arthroscopic double row repair of massive posterosuperior tear: healing and functional outcomes

The aim of this study was to evaluate the healing and functional outcomes of an arthroscopic repair for massive posterosuperior rotator cuff tears using 8 strands knotless double-row parachute technique. We hypothesized that this technique would lead to a high rate of healing and would restore functional range of motion (ROM).

To evaluate the healing and functional outcomes of arthroscopic repair for massive posterosuperior rotator cuff tears using an 8-strand knotless double-row parachute technique.

This retrospective single-center study included patients who underwent arthroscopic repair for massive posterosuperior rotator cuff tears between June 2018 and October 2022. Inclusion criteria were full-thickness tears involving at least 2 tendons, at least 1 tendon with retraction Patte grade 2, at least 1 tendon with fatty infiltration Goutallier grade 2 (or Fuchs equivalent), and absence of glenohumeral arthropathy beyond Hamada grade 2. A minimum of 12 months of clinical follow-up and post-operative magnetic resonance imaging at ≥6 months were required. All repairs were performed arthroscopically using an 8-strand knotless double-row "parachute" construct, designed to provide broad tendon compression and tension-free fixation. The primary outcome was the structural integrity of the repair on magnetic resonance imaging, classified according to Sugaya. Secondary outcomes included improvements in Constant score, Subjective Shoulder Value, visual analog scale for pain, range of motion, and complication rate. Subgroup analyses compared healed versus retear cases.

A total of 52 shoulders (51 patients; mean age 60.7 ± 7.6 years) were analyzed at a mean follow-up of 45.1 ± 16.1 months. The healing rate was 86.5% (45/52 shoulders), with 7 retears (13.5%). The Constant score improved from 51.6 ± 18.5 to 91.8 ± 18.5 (P < .001), visual analog scale from 4.8 ± 1.8 to 1.0 ± 1.1 (P < .001), and Subjective Shoulder Value from 54.8 ± 17.7 to 83.6 ± 14.0 (P < .001). Forward elevation increased from 133° ± 40° to 166° ± 11° (P < .001). Among healed repairs, 93% achieved the substantial clinical benefit for Constant score. All 8 patients (100%) with pre-operative pseudoparalysis regained active elevation >150° postoperatively. No infections, stiffness, or anchor-related complications occurred.

The arthroscopic 8-strand knotless double-row parachute technique is effective with a high healing rate reaching 86.5% and excellent clinical outcomes in patients with massive posterosuperior rotator cuff tears.