Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 +/- 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores (P< .001). The mean forward flexion was 163 degrees +/- 9.7 degrees, and the mean lateral abduction was 159.4 degrees +/- 9.4 degrees. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.