The “Safe Zone” Technique Improves Suture Placement and Accuracy During Arthroscopic Remplissage: A Cadaveric Validation of A Novel Technique

Abstract

Recent studies have raised concerns over accuracy of suture passage during arthroscopic remplissage. Our purpose was to validate if a previously described “safe zone” technique (SZ) for remplissage suture placement can improve accuracy of suture passage through the infraspinatus tendon. An arthroscopic remplissage was performed on 6 cadaveric specimens using a recommended “safe zone” suture passage technique, described as a region at least 1 cm lateral to the posterolateral acromion (PLA) and no greater than 3 cm distal. Two anchors were placed following, which sutures were shuttled through the posterior rotator cuff arthroscopically. Specimens were then dissected to analyze the accuracy of suture passage. Results were compared with a control group of 6 separate specimens where suture passage was done with standard techniques without use of the “safe zone” (SZ). A total of 24 suture passes were performed for each group. 83.3% (20/24) passed through the infraspinatus tendon in the SZ group. This was significantly improved compared with the control group where only 25% (6/24) pierced through the infraspinatus tendon (p<0.01). 4.2% (1/24) of attempted passes in the SZ group passed through the muscle or musculotendinous junction compared with 75% (18/24) in the control group (p<0.01). Prevention of over-medialization significantly improved using the SZ as represented by both anchors having suture passage significantly more lateral (6-10mm) than the control group (p<0.01). There was also an improvement in the precision of suture passes with utilization of the SZ, as overall precision (SD) improved in 75% of passes. We found the safe zone technique significantly improved accuracy of suture penetration into the infraspinatus tendon during arthroscopic remplissage. This technique also prevents over-medialization with regards to muscle penetration and over-distalization caused by teres minor penetration. The safe zone technique provides a reproducible method that may prove useful to prevent reported complications associated with remplissage.