Current evidence on All-Suture Anchors for Rotator cuff repair: A Scoping Review

Rotator cuff tears are among the most common causes of shoulder pain and dysfunction, and arthroscopic rotator cuff repair (RCR) has become the preferred treatment for symptomatic tears refractory to conservative management. Despite advances in surgical techniques, structural failure following repair remains a significant concern, with outcomes influenced by patient factors, tear characteristics, bone quality, surgical technique, and fixation method. Consequently, improvements in suture anchor technology have become a major focus to optimize tendon-to-bone healing. Suture anchors have evolved from metallic and bioabsorbable implants to polyetheretherketone (PEEK) and, more recently, all-suture anchors (ASAs). ASAs achieve fixation through expansion beneath the cortical bone after insertion via a small drill hole, preserving bone stock, enabling multiple anchor placement, reducing imaging artefacts, and potentially facilitating revision surgery. These advantages have led to their increasing use in arthroscopic RCR. However, concerns remain regarding the biomechanical performance of ASAs, particularly their pull-out strength, cyclic displacement, and fixation in poor-quality bone. While biomechanical and clinical studies generally report outcomes comparable to conventional anchors, findings remain inconsistent, and most available evidence is limited by retrospective study designs, short follow-up, and heterogeneous methodologies. Furthermore, the clinical significance of radiological findings such as tunnel widening and peri-anchor cyst formation remains unclear. This scoping review aims to comprehensively map the available evidence on the biomechanical, clinical, and radiological outcomes of all-suture anchors in arthroscopic rotator cuff repair, identify current indications, and highlight important gaps to guide future research.