Mid-term outcomes of arthroscopic single-row, tension-free repair for large and massive rotator cuff tears: A retrospective study of 35 cases

Objectives: Large to massive rotator cuff tears (RCTs) are challenging to handle because of tendon retraction, fatty infiltration, and limited mobility. In elderly patients, these tears often raise the question of primary arthroplasty. This study computed the clinical, functional, and radiological outcomes of arthroscopic single-row, tension-free repair in such patients. Materials and Methods: Thirty-five patients receiving arthroscopic single-row repair for large to massive RCTs were prospectively followed for a minimum of 24 months. Clinical outcomes were analyzed using Constant–Murley and University of California, Los Angeles (UCLA) scores. Tendon healing was assessed by ultrasonography, leveraging the Sugaya classification. Results: All patients demonstrated significant post-operative improvements. The constant score increased from 50.6 ± 10.18 to 91.43 ± 7.56 ( P < 0.00015) and the UCLA score from 18.03 ± 4.47 to 33.31 ± 2.68 ( P < 0.00022). Active forward flexion improved from 72.00 ± 29.08° to 152.57 ± 11.20° ( P < 0.00025) and external rotation from 54.86 ± 12.22° to 77.43 ± 11.72° ( P < 0.00034). Ultrasonographic evaluation showed a re-tear rate of 11.4%, with preserved function even in re-tear cases. Conclusion: Arthroscopic single-row, tension-free repair yields reliable mid-term improvements in function, pain relief, and tendon healing for large to massive RCTs in elderly patients. The technique offers a viable alternative to primary arthroplasty.