All-Suture Versus Conventional Solid Suture Anchors in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis of Clinical, Structural, and Anchor-Related Outcomes
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Background: All-suture anchors were developed to preserve greater tuberosity bone while providing fixation for arthroscopic rotator cuff repair. Although biomechanical evidence suggests performance comparable with conventional solid anchors, uncertainty remains regarding postoperative function, tendon healing, perianchor bone response, and anchor-related complications. Objective: To systematically evaluate and quantitatively compare clinical, structural, and anchor-related outcomes of all-suture versus conventional solid suture anchors in arthroscopic rotator cuff repair. Methods: PubMed was searched from inception through July 22, 2026 for comparative adult clinical studies evaluating all-suture anchors against metallic, polyetheretherketone, bioabsorbable, biocomposite, or other solid-body anchors. Randomized and nonrandomized comparative studies and within-patient imaging comparisons were eligible. Continuous outcomes were summarized as mean differences (MDs) and dichotomous outcomes as risk ratios (RRs), with 95% confidence intervals (CIs), using random-effects meta-analysis. Anchor-level imaging studies with non-independent observations were synthesized separately. Results: Thirteen comparative studies were included, and eight contributed to at least one patient-level meta-analysis. No significant differences were observed in Constant-Murley score (MD 2.43, 95% CI −0.87 to 5.73; I²=86%), ASES score (MD −1.77, 95% CI −5.66 to 2.12; I²=0%), VAS pain (MD −0.37, 95% CI −1.65 to 0.91; I²=85%), DASH score (MD −3.50, 95% CI −14.80 to 7.80; I²=78%), or forward flexion (MD 2.38°, 95% CI −2.12° to 6.87°; I²=0%). Structural failure was also inconclusive (RR 0.55, 95% CI 0.15 to 2.07; I²=53%). Patient-level perianchor fluid or cyst formation was less frequent with all-suture anchors (RR 0.47, 95% CI 0.25 to 0.89; I²=8%). Bone marrow edema and pullout estimates were heterogeneous and imprecise. Conclusion: All-suture anchors provide clinical and structural outcomes broadly comparable with conventional solid anchors while offering a bone-preserving fixation option. A lower risk of perianchor fluid or cyst formation was observed, but this finding was based on limited evidence. Larger randomized studies with standardized imaging and longer follow-up are required
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