Tear characteristics and surgeon influence repair technique and suture anchor use in repair of superior-posterior rotator cuff tendon tears

BACKGROUND: The factors that associate with surgical decisions about repair technique and the number of suture anchors used in rotator cuff repair have not been previously investigated. The purpose of this study was to investigate the extent to which patient and surgical factors, including surgeon, associate with performing single-vs. double-row repair technique and ultimately with the number of suture anchors used. METHODS: This study queried our institution’ sprospective surgical cohort for patients undergoing suture anchor repair of superior-posterior rotator cuff tendon tears between February 2015 and August 2017. Exclusion criteria were patients with isolated subscapularis tears, tears that were not repaired, repairs without suture anchors, repairs involving graft augmentation, and repairs by surgeons with less than 10 cases. Multivariable statistical modeling was used to investigate associations between patient and surgical factors and the choice of repair technique and number of suture anchors used. RESULTS: 925 cases performed by 13 surgeons met inclusion criteria. Tear type (full thickness), tear size (medium, large and massive), a greater number of torn tendons, repair type (arthroscopic), and surgeon were significantly associated with performing a double-row over a single-row repair. Tear size, a greater number of torn tendons, double-row repair technique, and surgeon were significantly associated with a greater number of anchors used for repair. CONCLUSION: Our findings suggest that in the absence of data to conclusively support a clinical benefit of one repair technique over another, the surgeons’ training, experience and/or inherent practice patterns, become the primary factors that define their surgical methods. LEVEL OF EVIDENCE: Level III; Cross-Sectional Design; Epidemiology Study