Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears

Purpose The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1 cm). Methods A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2 mm wide). Minimal follow-up required was 5 years. Changes in Murley-Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate. Results Fifty-four patients were included. Mean age was 57 +/- 4 years. The average follow-up was 68 +/- 10 months. Average preoperative score of Constant was 51.2 +/- 8.5 and 83.1 +/- 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 +/- 1.8 to 1.9 +/- 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3 degrees +/- 9 preoperatively to 169.6 degrees +/- 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3,p < 0.001.). The ASES score was significantly improved 49.1 +/- 13.1 vs. 88.6 +/- 15.8,p < 0.001). The MRI assessment revealed 94% of Sugaya 1-2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair. Conclusion The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization.