Abstract
Introduction: Rotator cuff tear with delamination is considered a risk factor for postoperative retear. The purpose of this study was to compare clinical outcomes between three repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and the combination of DLSB with modified Debyere-Patte (DLSB + DP). Methods: 53 shoulders of 52 patients who had massive rotator cuff tears with delamination were categorized into three groups: EMSB (18 shoulders), DLSB (24 shoulders), and DLSB + DP (11 shoulders). The mean postoperative follow-up period was 34.6 months. Pre- and postoperative evaluations included a range of motion (ROM), Constant scores, global fatty degeneration (GFDI), and tendon integrity according to Sugaya’s classification by magnetic resonance images (MRI). Results: In all groups, ROM significantly improved after the procedures. Mean constant scores significantly improved: from 45.5 to 77.4 after EMSB, from 45.5 to 87.6 after DLSB, and from 46.3 to 88.0 after DLSB + DP. Significant differences were noted in postoperative Constant scores (p = 0.018: DLSB vs. EMSB, and p = 0.045: DLSB + DP vs. EMSB). The Constant pain scores were better for DLSB + DP than for EMSB (p = 0.012). Global fatty degeneration index (GFDI) with DLSB + DP was significantly higher than that for either EMSB or DLSB, indicating significant preoperative fatty degeneration for DLSB + DP. Retear occurred in 27.8% of the EMSB group, 12.5% of the DLSB group, and 9.1% of the DLSB + DP group. Discussion: Comparisons of the three groups demonstrated that DLSB and DLSB + DP achieved better clinical outcomes than EMSB for the repair of large or massive rotator cuff tears. DLSB + DP is useful for massive rotator cuff tears with severe fatty degeneration or for cases where the presence of excessive tension is anticipated when repairing the torn cuff.
Highlights
The delamination of the rotator cuff has been described as a horizontal lesion between the superficial and deep layers [1, 2]
Delamination is observed in 36–82% of rotator cuff tear cases, and its presence is considered a risk factor for postoperative retear after rotator cuff repair [3,4,5,6,7]
Among patients surgically treated by arthroscopic rotator cuff repair (ARCR) at our hospital, between September 2011 and June 2018, there were 53 shoulders (52 patients) presenting massive rotator cuff tears, according to the DeOrio and Cofield classification, with delamination
Summary
The delamination of the rotator cuff has been described as a horizontal lesion between the superficial and deep layers [1, 2]. Delamination is observed in 36–82% of rotator cuff tear cases, and its presence is considered a risk factor for postoperative retear after rotator cuff repair [3,4,5,6,7]. An optimal fixation method for a rotator cuff stump with delamination has yet to be established. Double-row double-layer fixation is reported as a repair method of the stump of delaminated rotator cuff tears. There is a high incidence of retear in large and massive rotator cuff tear cases [2]. The suture bridge (SB) is a tendon stump fixation method for rotator cuff tears with a strong initial fixing force and provides favorable cuff integrity with its broad coverage footprint.
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