Single-Row Suture with Tension-Reducing Augmentation Versus Double-Row Suture Bridge Repair for Medium-to-Large U-Shaped Supraspinatus Tears: A Retrospective Cohort Study with 2-Year Follow-Up

Background Double-row suture bridge (DRS-B) repair is widely used for medium-to-large U-shaped supraspinatus tendon tears and yields satisfactory clinical outcomes. However, it is associated with higher surgical complexity, increased anchor, and potential complications—including stiffness, chondral injury, and hardware-related issues. Single-row suture repair combined with tension-reducing (SRS-TR) is an emerging alternative designed to simplify fixation while preserving tendon biology and reducing mechanical stress. This study aimed to compare the early-to-midterm clinical and radiographic outcomes of SRS-TR versus DRS-B for medium-to-large U-shaped supraspinatus tears. Methods Primary endpoints included A retrospective cohort study was conducted on 60 patients diagnosed with medium-to-large (2–5 cm in maximal width) U-shaped supraspinatus tears, who underwent arthroscopic repair between January 2020 and January 2025. Patients were allocated to either the SRS-TR group (n = 30) or the DRS-B group (n = 30) based on surgeon preference and intraoperative decision-making (no randomization). Evaluation indicators included intraoperative anchor usage, and acromiohumeral distance (AHD),length of hospital stay, follow-up duration, postoperative shoulder range of motion (ROM), visual analogue scale (VAS) for pain, UCLA Shoulder Rating Scale, American Shoulder and Elbow Surgeons (ASES) score, patient-reported surgical satisfaction, tendon integrity (Sugaya classification on MRI at ≥ 6 months), and retear rate. All assessments were performed at standardized intervals: baseline, 3 days, 3 months, 6 months, 12 months,24 monthsand final follow-up. Results The SRS-TR group demonstrated significantly shorter operative time (mean difference: −49.6 min, P = 0.033), lower anchor usage (mean 3 vs.4 anchors, P < 0.001), and reduced incidence of intraoperative anchor revision (0% vs. 13.3%, P = 0.038) compared with the DRS-B group. AHD was significantly greater in the SRS-TR group both at 3 days postoperatively (mean 9.91 mm vs. 7.12 mm, P = 0.022) and at final follow-up (mean 11.81 mm vs. 9.12 mm, P = 0.043), suggesting improved superior tendon reduction and less superior migration of the humeral head. No postoperative complications (infection, neurovascular injury, stiffness, or anchor-related adverse events) occurred in either group. There were no statistically significant differences between groups in hospital stay, follow-up duration,ROM,VAS,UCLA, ASES, surgical satisfaction, or retear rate (Sugaya Type IV–V: 3.3% in SRS-TR vs. 6.6% in DRS-B; P = 0.141). Conclusions At a mean follow-up of 23.1 months, both SRS-TR and DRS-B achieved comparable functional outcomes, pain relief, and patient satisfaction in patients with medium-to-large U-shaped supraspinatus tears. However, SRS-TR offered significant procedural advantages—including shorter operative time, reduced anchor burden, lower intraoperative revision rates, and superior maintenance of AHD—suggesting potentially enhanced biological healing and reduced mechanical strain on the repaired tendon. These findings support SRS-TR as a safe, efficient, and cost-effective alternative to DRS-B for selected U-shaped tears. Level of evidence Level III, comparative study