Arthroscopic transition from suture anchors to transosseous suture technique for treating rotator cuff tear with osteoporosis- a case report.

BACKGROUND

Rotator cuff repair using suture anchors (SA) is the current standard; however, in osteoporotic patients, anchor pullout can compromise surgical outcomes. Transosseous rotator cuff repair (TO-RCR), especially the Open-Box (OBOX) technique, has emerged as a viable anchorless alternative offering superior biomechanical advantages.

CASE PRESENTATION: A 73-year-old woman with a full-thickness rotator cuff tear and osteoporosis underwent arthroscopic SA repair. During surgery, anchor pullout occurred due to poor bone quality. The surgical team immediately transitioned to the OBOX technique, involving vertically crossed bone tunnels and eight-point tendon fixation using six high-strength sutures. Postoperative recovery was uneventful, with substantial improvements in range of motion and functional scores (Constant-Murley score: 93、UCLA score: 33 at 8 months). MRI confirmed successful tendon healing, demonstrating features of Sugaya type II classification.

CONCLUSION

This case demonstrates that the OBOX transosseous suture method may be a viable option when anchor failure occurs during rotator cuff repair, especially in osteoporotic patients. Further research is warranted to assess long-term outcomes and broader clinical applications.