Arthroscopic Suture Bridge Technique Research Articles

Arthroscopic Suture-Bridge Repair of the Subscapularis Tendon—“Inside and Outside the Box” With Preservation of the Comma Sign

The subscapularis muscle and its tendon are of major importance in the kinematics of the glenohumeral joint. Therefore, a diligent repair of subscapularis tears is essential. We describe our reliable standardized arthroscopic suture bridge technique to repair subscapularis tears under intra- and extraarticular visualization and with preservation of the “comma sign.” This technique provides excellent exposure of the subscapularis tendon, allows its complete release in the subcoracoid space and ensures a safe and stable repair.

Arthroscopic Suture-Bridge Repair Technique for an Avulsion of the Talar Insertion of the Anterior Talofibular Ligament

There are several studies about arthroscopic repair techniques for the lesion of the anterior talofibular ligament. However, the research concentrating on the avulsion of the talar insertion of the anterior talofibular ligament is very rare. Among 122 patients who suffered from recurrent ankle sprain and underwent arthroscopic anterior talofibular ligament repair from October 2016 to January 2019 in our hospital, 11 patients with an avulsion of the talar insertion of this ligament were diagnosed and then treated with the arthroscopic suture-bridge repair technique in the present study. The clinical outcomes were assessed using the Karlsson-Peterson score, Ankle and hindfoot score by American Orthopedic of Foot and Ankle Society, Sefton articular stability scale and Visual Analogue Scale. The complications were recorded at the time of observation. The median value of the follow-up time was 30 (range 18-36) months. At the final follow-up, the median value of the Karlsson-Peterson score, American Orthopedic of Foot and Ankle Society ankle-hindfoot score, and Visual Analogue Scale score was 90, 90, 1, respectively. Based on the Sefton stability scale, 10 cases were in the excellent or good category. No wound infections and no neurovascular injuries were encountered, also no case required revision surgery. Only 1 patient complained about mild local irritation at the knotless anchor site. The arthroscopic suture-bridge technique could be suitable for treatment of an avulsion of the talar insertion of the anterior talofibular ligament due to satisfactory activity recovery and few complications.

Comparison of early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in treatment of avulsion fracture of posterior cruciate ligament insertion

To compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion. Between June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups ( P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation. Both groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups ( t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation ( P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group ( P<0.05). Arthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.

An assessment of the functional outcomes of patients undergoing early exercise physiotherapy following arthroscopic rotator cuff repair using the double-row suture bridge technique

&lt;ol&gt;&lt;li&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The methods of repairing rotator cuff tear are single-row technique, traditional double-row technique and suture-bridge technique. Studies have shown that the arthroscopic suture-bridge technique improved the pressurized contact area between the tendon and footprint. Controversy exists regarding the influence of early versus delayed motion on stiffness and healing rate after cuff repair. Early motion rehabilitation increases range of motion after cuff repair, although risk of re-tear is higher compared to immobilization. This study evaluated the functional outcomes in patients who underwent arthroscopic rotator cuff repair using the suture-bridge technique followed by an early exercise physiotherapy regime.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was a prospective and retrospective analysis of patients treated arthroscopically for rotator cuff tears in Hosmat hospital, Bangalore. 30 patients who had only a supraspinatus/infraspinatus tear were included in the study. The functional outcome was assessed by two scoring systems, UCLA and ASES scores. Post operatively, patients were immobilized for 3 weeks only. They were followed up at 3 weeks, 6 weeks, 12 weeks and at 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study had 20 patients reporting a good outcome, whereas 9 patients had a fair outcome. Only 1 patient reported a poor outcome. The mean ASES scores improved from 20.43 to 77.87 whereas the UCLA score improved from 10.03 to 27.93. None had re-tears.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The arthroscopic suture-bridge technique resulted in acceptable patient satisfaction and functional outcome as 67% of our patients had a “good” outcome. Early ROM exercise accelerated recovery from postoperative stiffness for patients after arthroscopic rotator cuff repair. &lt;/li&gt;&lt;/ol&gt;

Modified Double-Row Suture Bridge Technique With Double-Row Biceps Tenodesis for Massive Rotator Cuff Tear

This article aims to describe a modification of the arthroscopic suture bridge technique for repair of a massive (>3 cm) rotator cuff tear. The method uses 2 medial anchors and 2 lateral anchors for rotator cuff repair, as well as double-row biceps tenodesis. This operative modification may impart better tendon healing and fewer rupture complications than the traditional double-row repair techniques.

Comparison of outcome of tibial avulsion fracture of the posterior cruciate ligament using open reduction internal fixation by cc screw and arthroscopic suture bridge technique

Introduction: Number of operative techniques have been described with the use of lag screws, steel wires, arthroscopic tight rope fixation, arthroscopic suture bridge technique. As there is continuous advancement in newer technique, we are comparing outcome of PCL tibial avulsion fixed by two different methods open reduction internal fixation by CC screw and arthroscopic suture bridge technique. Method: The PCL tibial avulsion was approached by posterior Burks and Schaffer approach, fixed by CC screw in half of the patient and in another half, we used arthroscopic suture bridge technique. One fiber wire is used in arthroscopic technique. Results: Anatomical reduction and fixation of PCL avulsion by arthroscopic fixation is equally effective when compared with ORIF by CC screw fixation. Conclusion: The use of CC screw could be a simple and reliable technique for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery, but arthroscopic suture bridge technique of PCL avulsion fixation gives better knee function and less intraoperative complications.

Comparison of arthroscopic suture-bridge technique and double-row technique for treating rotator cuff tears: A PRISMA meta-analysis.

Background:Rotator cuff tear is a common shoulder disorder in the elderly. Either arthroscopic double-row (DR) or suture-bridge (SB) technique for rotator cuff tear patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic SB versus DR intervention.Methods:The 7 studies were acquired from PubMed, Medline, Embase, CNKI, Google, and Cochrane Library. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle–Ottawa scale were used to assess risk of bias.Results:Seven studies including 1 randomized controlled trial and 6 observational studies were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion showed that the differences were not statistically significant between the 2 interventions. The difference of University of California at Los Angeles (UCLA) score was statistically significant between SB and DR intervention, and SB treatment was more effective (MD = −0.95, 95% CI = −1.70 to −0.20, P = .01). The difference of re-tear rate was statistically significant and SB treatment achieved better result than DR treatment (OR = 0.31, 95% CI = 0.15–0.64, P = .001). Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent.Conclusions:Both arthroscopic SB and DR interventions had benefits in rotator cuff tear. SB treatment was more effective in UCLA score and had lower re-tear rate than DR treatment. The arthroscopic SB technique is recommended as the optical choice for rotator cuff tear.

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p<0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p=n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p=0.035). Fatty infiltration (postoperative global fatty degeneration index, p=0.022) and muscle hypotrophy (postoperative OR, p=0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture.

This study examined the clinical outcomes of a newly developed technique, arthroscopic suture bridge fixation with crossover ties of PCL tibial avulsion fracture using two tibial tunnels and a posterior trans-septal portal. Records were reviewed of 18 patients (median age 33.5years, range 13-55years) with PCL tibial avulsion fractures treated with an arthroscopic suture bridge technique. Knee function before surgery and at last follow-up was evaluated by Lysholm and Tegner scores. A KT-2000 arthrometer was used to evaluate knee stability, and fracture union was assessed by plain radiographs. Mean postoperative Lysholm (P<0.001) and Tegner (P=0.011) scores showed significant improvements compared with preoperative scores. Arthrometry showed that the mean side-to-side difference improved significantly, from 7.8±0.8mm preoperatively to 3±1.2mm postoperatively (P=0.012). Radiographic evaluation showed solid union at the fracture site in all 18 patients at last follow-up. This new arthroscopic double-tunnel pull-out suture bridge fixation with multiple crossover ties and posterior trans-septal technique for PCL tibial avulsion fracture yielded good clinico-radiological outcomes, including satisfactory stability and fracture site healing. This technique can be a useful treatment option for PCL tibial avulsion fracture even with small comminuted fracture due to compression by the unique crossover configuration mesh of multiple fixation sutures. IV.

Research progress on suture and fixation approach of arthroscopic rotator cuff repair in suture-bridge technique

With advances in arthroscopic surgery, arthroscopic repair for rotator cuff tears is often used by surgeons. Surgical methods have already developed from simple single-row fixation and double-row fixation to complicated suture-bridge fixation. Although arthroscopic suture-bridge rotator cuff repair has been proposed to be advantageous over single-row and double-row fixation in biomechanical constructs, the failure of rotator cuff repair is still higher. Different suture methods of medical row anchor in arthroscopic suture-bridge technique may change the suture-tendon loading and decrease the retear of suture-tendon. And different fixation methods of lateral row anchor in arthroscopic suture-bridge technique may decrease the anchor pull-out. These will be useful to decrease the failure of arthroscopic suture-bridge technique. There will be a good outcome if optical suture and fixation approach can be chosen according to the quality and retraction of rotator cuff, suture tension and the bone quality of the greater tuberosity in arthroscopic suture-bridge technique.

Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws

The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented. 237 patients (m = 142, f = 95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M. G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83 %, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerber's shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated. In SSG a highly significant improvement from 51 to 83 points was found (p < 0.001). In CS 80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5 % 5.1 years postoperative (p < 0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6 %, the relative re-tear rate 17.6 %. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5 % were found. The patient's age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p < 0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p < 0.001) which also resulted in a significantly better outcome in the CS (p < 0.01). The costs for open titanium transfixation technique with 330 € per case are markedly less than for arthroscopic suture bridge technique with 600 to 1000 € per case. Open double-row cuff repair with titanium screws is a safe and cost effective technique with a low re-tear rate with comparable clinical results regarding open and arthroscopic procedures.

Modified Suture-Bridge Technique to Prevent a Marginal Dog-Ear Deformity Improves Structural Integrity After Rotator Cuff Repair

Background: The arthroscopic suture-bridge technique has proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing the footprint contact area and pressure. However, a marginal dog-ear deformity is encountered not infrequently when this technique is used, impeding full restoration of the torn cuff. Purpose: To evaluate the structural and functional outcomes of the use of a modified suture-bridge technique to prevent a marginal dog-ear deformity compared with a conventional suture-bridge method in rotator cuff repair. Study Design: Cohort study; Level of evidence 2. Methods: A consecutive series of 71 patients aged 50 to 65 years who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears was evaluated. Patients were divided into 2 groups according to repair technique: a conventional suture-bridge technique (34 patients; group A) versus a modified suture-bridge technique to prevent a marginal dog-ear deformity (37 patients; group B). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) score. All patients were followed up clinically at a minimum of 1 year. Result: When the 2 surgical techniques were compared, postoperative structural integrity by Sugaya classification showed the distribution of types I:II:III:IV:V to be 4:20:2:4:4 in group A and 20:12:4:0:1 in group B. More subjects in group B had a favorable Sugaya type compared with group A (P < .001). The postoperative healed:retear rate was 26:8 in group A and 36:1 in group B, with a significantly lower retear rate in group B (P = .011). However, there were no significant differences in ROM and all functional outcome scores between the 2 groups postoperatively. When surgical techniques were compared across healed (n = 62) and retear (n = 9) groups, significantly fewer modified suture-bridge technique repairs were found in the retear group (P = .03). There were significant differences between healed and retear groups in functional outcome scores, with worse results in the retear group. Conclusion: A modified suture-bridge technique to prevent a marginal dog-ear deformity provided better structural outcomes than a conventional suture-bridge technique for medium-sized to massive rotator cuff tears. This technique may ultimately provide better functional outcomes by decreasing the retear rate.

Arthroscopic Suture Bridge Technique for Intratendinous Tear of Rotator Cuff in Chronically Painful Calcific Tendinitis of the Shoulder

Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports.

Arthroscopic Suture Bridge Fixation of Tibial Intercondylar Eminence Fractures

Tibial intercondylar eminence fractures that are displaced and non-reducible require open or arthroscopically assisted repair. Ideally, fracture reduction and fixation would be performed with a technique that has low morbidity, allows easy visualization and reduction, provides firm fixation, does not violate the proximal tibial physis, avoids metal hardware, and does not require a second procedure for implant removal. The suture bridge technique, used in the shoulder for rotator cuff tears and greater tuberosity fracture repair, has the ability to produce high contact pressures with rigid fixation. We describe an all-inside and all-epiphyseal arthroscopic suture bridge technique for tibial intercondylar eminence fracture repair performed with PushLock anchors (Arthrex, Naples, FL). One or 2 anchors preloaded with No. 2 FiberWire (Arthrex) are placed in the posterior fracture bed, followed by fracture reduction. The suture limbs are shuttled through and around the anterior cruciate ligament and over the fracture fragment in crossing fashion and are secured by use of additional anchors placed at the anteromedial and anterolateral fracture margin. The anchors are placed obliquely to avoid the proximal tibial physis in the pediatric population. Anatomic reduction and secure fixation allow more aggressive rehabilitation and faster restoration of joint function.

The outcomes of arthroscopic suture bridge technique for treatment of full thickness rotator cuff tear

Objective To discuss and evaluate the arthroscopic suture bridge technique for treatment of full thickness rotator cuff tear.Methods Between January 2009 and June 2010,22 cases of full-thickness rotator cuff tears were treated by arthroscopic suture bridge technique,and the results were analyzed statistically.Results All the patients were reviewed and the average follow-up period was 25.8 months (range,18 to 35 months).Average tear measured (3.60± 0.25) cm and no anchor was loosened.At the last follow-up,the range of active forward flexion,abduction,external rotation at the side improved (P ＜ 0.001) and muscle strength of forward flexion,external rotation at the side also improved obviously (P ＜ 0.05) when compared to the pre-operative evaluations.The average American shoulder and elbow surgeons (ASES) score improved from 66.5 to 90.6 (P ＜ 0.001).The average Constant score improved from 64.4 to 93.8 (P ＜ 0.001).All the patients were satisfied with the operations.Conclusion The arthroscopic suture bridge technique was successful for treatment of full thickness rotator cuff tear. Key words: Arthroscopes; Full thickness; Rotator cuff tear; Suture bridge technique

Does an Arthroscopic Suture Bridge Technique Maintain Repair Integrity?: A Serial Evaluation by Ultrasonography

Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Arthroscopic Reduction and Fixation With Suture-Bridge Technique for Displaced or Comminuted Greater Tuberosity Fractures

Abstract The arthroscopic suture-bridge technique (transosseous equivalent technique) was initially described for increasing the footprint size during arthroscopic rotator cuff repair. We describe a method in which the same principles are used to fix a displaced or comminuted greater tuberosity fracture. The technique involves reducing the displaced fragment with two medially placed, trans-tendinous anchors and compressing the greater tuberosity using the sutures from these medial anchors in two laterally placed anchors. The two medial anchors are inserted through the junction of the cuff and fragment. The anchor driver can be used as a joystick to reduce the fragment into position. One suture limb of each anchor is passed back through the tendon 5 mm from the original anchor insertion point in the tendon. With the scope in the subacromial space, the sutures from the medial anchors are tied in a mattress configuration. The four suture ends are passed distally over the greater tuberosity and incorporated into two PushLock anchors (4.5 mm; Arthrex, Naples, FL) using the suture-bridge technique. The postoperative rehabilitation protocol is similar to that for rotator cuff repairs.