Abstract
BACKGROUND: Arthroscopic rotator cuff repair is commonly performed using suture anchors. However, implant-free transosseous (TO) fixation has re-emerged as a cost-effective alternative designed to avoid anchor-related complications. The present study directly compares key clinical outcomes, including pain reduction, functional improvement (assessed by the Oxford Shoulder Score (OSS)), range of motion, and postoperative complications between TO and anchor-based (AB) arthroscopic rotator cuff repair, aiming to determine whether the anchorless approach yields equivalent or superior clinical results. METHODS: In this retrospective cohort with prospective follow-up, 90 patients (mean age 56.1 ± 8.1 years; 55.6% men) underwent arthroscopic rotator cuff repair between January 2023 and May 2025. Procedures used either TO bone tunnels (n = 42) or double-row AB anchors (n = 48). Pain (visual analogue scale (VAS)), OSS, range of motion, and complications were recorded preoperatively and at 6 and 12 months. RESULTS: Baseline characteristics were comparable between groups. Both techniques produced significant improvements: VAS decreased from 6.9 ± 0.7 to 0.7 ± 0.5, and OSS increased from 12.3 ± 1.5 to 32.5 ± 1.5 at 12 months (p < 0.001). Outcomes did not differ between TO and AB repair (VAS, p = 0.95; OSS, p = 0.23). Flexion and abduction improved to ∼165°, and 90% achieved internal rotation to T10 or higher. CONCLUSION: Arthroscopic TO rotator cuff repair is a safe and effective alternative to AB methods, providing comparable improvements in pain, shoulder function, and range of motion at one year. Its implant-free design may reduce implant-related complications as supported by prior studies, though these advantages warrant confirmation in future randomized trials.