Clinical outcomes of modified Kessler tension-reducing suturing combined with double-row repair for Patte II–III rotator cuff tears

Background To determine the clinical outcomes of managing Patte grade II–III rotator cuff tears via a knotless medial-row double-row technique, integrated with modified Kessler tension-reducing suturing and lateral-row tension-reducing anchor fixation. Methods Between June 2022 and June 2024, a retrospective controlled study was instituted at the Affiliated Hospital 6 of Nantong University and Affiliated Qidong People's Hospital of Nantong University to assess a specific surgical intervention. Our cohort comprised 15 patients presenting with Patte grade II to III rotator cuff tears. The arthroscopic procedure utilized for all participants incorporated a knotless medial-row double-row technique, integrated with modified Kessler tension-reducing suturing and lateral-row tension-reducing anchor fixation. The cohort consisted of 10 females and 5 males. The right shoulder was affected in 11 cases and the left in 4. The mean age was 57 ± 7.9 years, and no patient reported a history of acute trauma. All patients underwent preoperative magnetic resonance imaging (MRI) to characterize the extent of rotator cuff pathology. Tear severity was graded according to two established systems: the Cofield classification identified 8 large and 7 massive tears, while the Patte system demonstrated grade II retraction in 9 cases and grade III retraction in 6. Concurrently, a control group of 17 patients who underwent standard knotless double-row medial repair was enrolled for comparison, comprising 11 females, 6 males; mean age 55 ± 10.3 years. This cohort included 10 right and 7 left shoulders, with tear sizes classified as large ( n = 10) and massive ( n = 7) according to the Cofield system. Furthermore, Patte grading identified 12 cases of type II and 5 cases of type III tears within this group. Results ① Preoperative functional assessment demonstrated no significant difference in ASES scores between the two groups. All procedures were completed without intraoperative complications. Postoperative follow-up ranged from 12 to 16 months (mean, 14.2 months), and no patients were lost during the study period. ② All patients achieved uneventful primary healing without perioperative complications. While the study group required a slightly longer operative time (87.2 ± 35.1 vs. 80.8 ± 32.1 min), this difference did not reach statistical significance. Notably, the 6-month structural assessment revealed a 100% healing rate in the study group. In contrast, the control group demonstrated inferior structural outcomes, with four patients experiencing failures, including one full-thickness and three partial-thickness retears. ③ Functional outcomes, as assessed via the American Shoulder and Elbow Surgeons (ASES) score, exhibited a notable upward trend across both cohorts during the 12-month follow-up period. Beginning from statistically comparable preoperative baseline values (study group: 42.4 ± 7.8; control group: 44.1 ± 9.2), the study group demonstrated consistently more favorable recovery trajectories. At 3, 6, and 12 months postoperatively, the ASES scores of the study group were 54.6 ± 9.2, 82.6 ± 7.5, and 91.6 ± 6.3, respectively—values that exceeded those of the control group (45.6 ± 11.3, 75.2 ± 10.8, and 85.3 ± 7.9, respectively). Notably, the functional superiority of the study group was most pronounced at the 12-month final assessment, with this difference reaching statistical significance ( P < 0.05). Conclusions By synergizing a knotless medial-row repair with a modified Kessler tension-reducing suturing technique and lateral-row tension-relieving fixation, this surgical strategy is designed to redistribute suture-end tension and may provide a more favorable biomechanical and biological environment for tendon-to-bone healing. Our findings suggest that this modified technique may be associated with improved structural healing quality and better short-term functional recovery compared with conventional knotless double-row repair, although causality cannot be established because of the retrospective design and limited sample size.