Is the Modified TOE Technique a Viable Alternative to Classical Knotted Repair for Rotator Cuff Tears? A Comparative...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Rotator cuff tears are common injuries, often treated with surgical repair.
• Transosseous-equivalent (TOE) repair techniques aim to improve tendon healing and functional outcomes.
• The use of knots in medial-row fixation can potentially increase tension and technical complexity.

Purpose of the Study:

• To compare clinical and radiological outcomes of classical knotted transosseous-equivalent (TOE) rotator cuff repair versus a modified knotless TOE technique.
• To evaluate the impact of eliminating medial-row knots on tendon healing and functional recovery in rotator cuff repair.

Main Methods:

• Retrospective review of 89 patients undergoing arthroscopic rotator cuff repair (2021-2023).
• Patients divided into classical knotted TOE (n=45) and modified knotless TOE (n=44) groups.
• Functional outcomes assessed using ASES, UCLA, QuickDASH, and Modified Constant Scores; Range of Motion (ROM) and MRI for rerupture evaluated.

Main Results:

• Both groups showed significant preoperative improvements in clinical scores and ROM (p < 0.001).
• No significant differences were found between groups in postoperative ASES, UCLA, QuickDASH, Modified Constant Scores, or ROM (p > 0.05).
• Rerupture rates were similar: 8.9% in the knotted group vs. 6.8% in the knotless group (p > 0.05).

Conclusions:

• The modified knotless TOE rotator cuff repair technique yields outcomes comparable to the classical knotted TOE technique.
• The knotless technique may offer advantages in reduced medial-row tension and technical ease.
• This modified approach represents a reliable alternative for arthroscopic rotator cuff repair.