Background: The present study aimed to determine how repair technique influenced structural and clinical outcomes at 5 years post-surgery. Methods: Three cohorts of patients had repair of a symptomatic rotator cuff tear using (i) an open double-row mattress repair technique (n ¼ 25); (ii) arthroscopic single-row simple suture knotted technique (n ¼ 25); or (iii) arthroscopic single-row inverted mattress knotless technique (n ¼ 36) by one surgeon. Standardized patient-and examinerdetermined outcomes were obtained pre-operatively and postoperatively with a validated protocol, ultrasound were also performed at the same time.Results: Retear occurred more often after open repair (48%) at 5 years than after arthroscopic knotted (33%) and arthroscopic knotless (26%) repair. Retear was associated with increasing age, pre-operative tear size and weaker preoperative and 5 years postoperative cuff strength. Between 2 years and 5 years, the open repair group experienced an increase in the frequency of pain during activity, as well as in the difficulty experienced and the severity of pain during overhead activities (p < 0.05) and, at 5 years, also experienced more difficulty with overhead activities, compared to the arthroscopic knotless repair group. Conclusions: At 5-year follow-up, arthroscopic rotator cuff repair techniques resulted in fewer retears and better outcomes compared to an open double-row technique.
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