Arthroscopic rotator cuff repair (ARCR) is the gold standard for full-thickness rotator cuff repairs [1]. There are two main types of rotator cuff repair methods: the anchor method and the transosseous method. Among the anchor-based methods, single-row (SR), double-row, and suture bridge repair techniques have emerged in recent years with advances in anchors. Recently, arthroscopic transosseous-equivalent suture bridge (TOE) repair has become a popular technique and is an effective treatment option for symptomatic rotator cuff tears with favorable clinical outcomes [[2], [3], [4]]. However, with the evolution of anchor methods, an increasing number of procedures requiring more anchors are being performed, and there are concerns that this will lead to higher medical costs.

The transosseous method has evolved as an alternative procedure, and excellent clinical results have been reported [[5], [6], [7], [8]]; however, the transosseous method is generally considered complicated and time-consuming, as the use of a giant needle or an anterior cruciate ligament guide may be required [9,10], which limits its application. Recently, with the introduction of L-shaped devices specifically designed for ARCR, good short-term clinical results have been reported, although an association with a complication of bone tunnel laceration has been observed [8]. We reported that the bone tunnel laceration can be prevented by arthroscopic transosseous ARCR using L-shaped devices with a lateral cortical bone augmentation (TOA) method, with good short-term clinical results [11]. Moreover, the cost of implantation could be lower due to the minimal number of anchors used [12]. However, there are no reports comparing implant costs, surgical time, clinical outcomes, and cuff repair integrity between TOA and TOE.

This study aimed to compare implant costs, surgical time, short-term clinical results, and cuff repair integrity at 2 years postoperatively between the TOA and TOE methods. We hypothesized that although there was no difference in clinical outcomes and cuff repair integrity between the two methods, implant cost is lower and surgical time is shorter for TOA than for TOE.