Arthroscopic Suture Research Articles

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

Background: Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs). Purpose: To compare clinical outcomes and tendon integrity between knotless layer–by–layer and conventional en masse repair techniques for delaminated RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer–by–layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI. Results: Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow–up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; P = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; P = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 (P = .046). Conclusion: En masse repair using the suture bridge technique and the knotless layer–by–layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer–by–layer technique.

Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis.

Background:Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the differences in clinical outcomes between them remain inconclusive.Purpose:To conduct a meta-analysis comparing the clinical and functional outcomes between arthroscopic screw fixation and suture fixation for tibial avulsion fractures.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Inclusion criteria were English-language articles that compared functional outcomes after screw fixation versus suture fixation for tibial avulsion fractures and had at least 1-year follow-up. Relevant data were extracted and analyzed statistically using the Mantel-Haenszel method and variance-weighted means. Random-effects models were used to generate pooled relative risk (RR) estimates with confidence intervals (CIs).Results:Of 1395 articles initially identified, we included 5 studies with 184 patients (91 patients with screw fixations and 93 patients with suture fixations). The pooled results indicated similar postoperative outcomes for screw fixation and suture fixation: Lysholm score (mean difference [MD], −0.32 [95% CI, −6.08 to 5.44]; P = .91), proportion of International Knee Documentation Committee score grade A (74% vs 74%; RR, 0.63 [95% CI, 0.10-3.95]; P = .63), Tegner score (MD, 0.10 [95% CI: −1.73 to 1.92]; P = .92), and Lachman test results (stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16; P = .90). Patients in the screw fixation group had a significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33; 95% CI,1.51-3.60; P = .0001) and implant removal rate (44% vs 3%; RR, 8.52; 95% CI, 3.58-20.29; P < .00001) compared with those in the suture fixation group. Nonimplant-related subsequent surgery rates were similar for the 2 groups.Conclusion:The findings indicated a higher risk of subsequent surgery (RR, 2.33) and implant removal (RR, 8.52) after screw fixation when compared with suture fixation for tibial avulsion fractures. However, there were no significant differences in clinical outcome scores between the 2 techniques.

Clinical Outcomes of the Arthroscopic Transosseous Suture Repair of the Rotator Cuff Using Absorbable Thread for the Medial Mattress Suture

We performed arthroscopic transosseous suture repair of the rotator cuff (ATOS) using absorbable threads for the medial mattress suture to prevent re-tear of the cuff at the medial mattress suture. This study aimed to evaluate the clinical outcomes of this procedure.

Functional outcome of acute tibial eminence fractures treated with arthroscopic assisted pull-through suture technique: A prospective case series

Background and Objective: There is an increased incidence of tibial eminence fractures in skeletally mature adults due to increased road traffic accidents and participation in sports activities (reference). The study has been undertaken to evaluate the functional outcome of acute tibial eminence fractures treated arthroscopically with a pull-through suture technique.Methods: This study included thirty-one patients with acute tibial eminence fractures treated arthroscopically between November 2019 and March 2021. All the fractures were fixed using a pull-through suture technique and tied over the suture disc.Results: Among the thirty-one patients treated, the most common cause of injury was a road traffic accident, followed by sports injuries. Two patients were injured due to a kick by the bull. In sports injuries, Kabaddi was the most prevalent cause of anterior cruciate ligament damage. Males made up 29 (94%) cases, while females made up just 2 (6%). The majority of the patients were between the ages of 40 and 49 (45 per cent). 64.5 per cent of patients (n=20) had surgery within five days of their accident. In our study, the mean preoperative IKDC scores were 50.94, and the mean postoperative IKDC scores were 87.73, indicating a considerable improvement. The mean pre-operative Lysholm score was 60.1, and postoperative Lysholm scores were 91.5. One patient had five degrees of extensor lag, and one patient had a fixed flexion deformity at ten degrees due to poor compliance to rehabilitation. Patients showed significant improvement by the end of 3 months and were allowed to return to daily activities by the end of 3 months and sports by six months. The percentage of patients who ended up having good to excellent outcomes is 83.8 and the percentage of patients returning to pre-injury level is 70.Conclusion: Treating acute tibial eminence fractures with an arthroscopic pull-through suture technique gives good rigid fixation and improves the functional outcome.

Prospective study of functional outcome of arthroscopic suture pull out fixation of displaced tibial spine avulsion fracture

Background: Tibial eminence avulsion fractures commonly occur in children and adolescents aged between 8 and 14 years. A valgus-directed force associated with an external torsion when the knee is in hyperextension is the most frequently referred mechanism, which closely resembles the one for anterior cruciate ligament (ACL) tears. This happens because the epiphyseal ossification process reaches the tibial eminence only in late childhood or adolescence, leaving this area more vulnerable to tensile forces than the ACL itself. In adults, this lesion is rare and associated either with high- energy trauma, boot-induced injuries in skiers or forced internal rotation with a flexed knee. Avulsion fractures may either involve the intercondylar depression where the ACL insertion lies only or, less frequently, the entire tibial spine with medial and lateral plateau.Materials and Methods: From November 2019 to December 2020, an intervention clinical study was carried out at Sanjay Gandhi institute of trauma and orthopaedics, A number of 30 patients having avulsion tibial spine fracture classified Meyers & McKeever Type II, TYPE III and IV were involved in our study.Results: Fractures were united within 3 months after surgery in all 30 cases. The Lysholm score was improved to 98(98.17 ± 1.599). In 2 patients, post operative knee stiffness was noted and arthrolysis was done for the same. All patients returned to their pre-injury physical activities at the last follow-up. Conclusion: Arthroscopic suture pull-out fixation for type III and IV tibial spine avulsion results in excellent clinical and radiological outcomes in patients with open and closed physis without any significant complications.

Clinical and Radiographic Outcomes After Arthroscopic Inlay Bristow Surgery With Screw Versus Suture Button Fixation: A Comparative Study of 117 Patients With 3.3-Year Follow-up.

Background:Some studies have advocated the use of suture button fixation during Bristow-Latarjet surgery to reduce complications associated with screw fixation. However, data comparing these fixation methods are relatively incomplete.Purpose:To investigate the efficacy of modified arthroscopic Bristow-Latarjet surgery and compare the clinical and radiographic outcomes using screw versus suture button fixation.Study Design:Cohort study; Level of evidence, 3.Methods:We evaluated 136 patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow-Latarjet surgery between June 2015 and February 2018. Of these patients, 117 who met the inclusion criteria were enrolled at a mean follow-up of 3.3 ± 0.7 years. Shoulders were separated into 2 groups based on fixation technique: screw fixation (group A; n = 63) or suture button fixation (group B; n = 54). Computed tomography imaging findings and clinical results were assessed preoperatively; immediately after operation; and postoperatively at 3 months, 6 months, 1 year, and final follow-up.Results:There were no significant differences between the groups in terms of postoperative clinical scores, the level of return to sports, range of motion, graft position, or reoperation rates. Bone healing was observed in 97.4% of the cases overall (114/117), with 98.4% bone union in group A and 96.3% in group B at final follow-up. Bone absorption was more common in group A (n = 30; 47.6%) compared with group B (n = 10; 18.5%) (P = .003). There were no hardware-related complications in group B, compared with 7.9% of patients in group A (P = .034). One patient in group B had a recurrent dislocation due to an unexpected event, and there were no recurrent dislocations in group A.Conclusion:After the modified arthroscopic Bristow-Latarjet procedure, both suture button and screw fixation methods demonstrated high bony healing rates and low risk of recurrence. Less coracoid graft resorption and no hardware-related complications were seen with suture button fixation.

Perioperative Nursing of Knee Joint Function Recovery in Patients Undergoing Arthroscopic Meniscus Injury Suture and Its Influence on Patients' Satisfaction

Perioperative Nursing of Knee Joint Function Recovery in Patients Undergoing Arthroscopic Meniscus Injury Suture and Its Influence on Patients' Satisfaction

Лечение пациентов с повреждениями менисков коленного сустава

The aim: to study the results of surgical treatment of patients with injuries of the meniscus of the knee joint, in whom arthroscopic suturing of the meniscus was used according to the developed technique.Methods. In this paper, we studied the results of surgical treatment of 134 patients with chronic injuries of the meniscus of the knee joint, who were treated at the City Clinical Hospital No. 7 in Almaty for the period from 2017 to 2021. 70 (52.3%) patients made up the control group, who underwent meniscus resection using arthroscopic technique. The main group included 64 (47.7%) patients with ruptures of the meniscus of the knee joint. He performed a meniscus suture under arthroscopic control according to the method developed by us (RK patent No. 35413 dated 12/10/2021). Results. Clinical application of a new method of arthroscopic meniscus suturing in patients of the main group allowed to increase the frequency of excellent results by 7.3% (p=0.012), good treatment results by 19.7% (p&lt;0.001) according to the Lysholm scale compared with the control group. The treatment outcomes of patients in the study groups, analyzed using the criteria of evidence-based medicine, indicate the effectiveness of a new method of arthroscopic meniscus suturing, which reduces the frequency of unsatisfactory outcomes in the long-term period of surgical treatment by 5.5% (p=0.184) compared with the control group.Сonclusions.The results of the research work support the arthroscopic repair of meniscal tears with good long-term results and a low risk of complications. Thus, a new method of arthroscopic suturing of the meniscus provides prevention of the development of contractures, gonarthrosis in the postoperative period in patients with injuries of the meniscus of the knee joint and allows for early functional treatment compared to traditional arthroscopic meniscectomy.Keywords: knee joint, menisci, meniscus injury, osteoarthritis, arthroscopy, meniscus suture, meniscus resection.

Improved arthroscopic high-strength suture fixation for the treatment of posterior cruciate ligament avulsion fracture.

Background: To investigate the curative effects of improved non-absorbable high-strength fixation under arthroscopy on posterior cruciate ligament (PCL) avulsion fracture. Methods: A retrospective analysis was performed on 16 cases of PCL avulsion fracture in 15 patients who underwent high-strength suture fixation under arthroscopy from December 2017 to November 2019. According to the Meyers-McKeever classification, there were 2 cases of type II and 14 cases of type III. The fracture was reduced under arthroscopy, and knotted and fixed under the anterior and medial skin of the knee joint with high-strength sutures and a button plate. Regular follow-up of the knee joint healing and stability, the range of motion and the functional recovery of affected limb was conducted. The last follow-up was completed after the button plate was taken out. The Lysholm score was used to assess the recovery situation. Results: The button plate was taken out 6-9months (average 7.2months) after surgery. At the last follow-up, the fractures of the 15 patients were all healed. Moreover, six patients were positive for posterior drawer test within Grade 1 and the others were negative. All patients had no knee extension limitation, and the range of knee flexion reached more than 120°, with an average of (132.4 ± 3.6)°. The average Lysholm score was (93.1 ± 4.7). There were significant differences in knee flexion angle and Lysholm score at different time points after operation, p = 0.000. Conclusion: For the treatment of PCL avulsion fracture, the optimized arthroscopic high-strength suture fixation is easy to perform and repeat, and the fixation is strong and solid. The functions of the knee joint experienced good recovery after the surgery.

LUtarjet-limit unique coracoid osteotomy Latarjet (With video).

BackgroundThe Latarjet procedure is an effective technique for the treatment of recurrent anterior shoulder dislocation with glenoid bone loss. However, the inevitable destruction of the coracoacromial arch may result in humeral head translation. The aim of the study is to introduce a modified Latarjet technique with coracoacromial arch preservation as well as its short term clinical outcomes.MethodsWe propose a novel individualized flexible arthroscopic suture button fixation Latarjet technique called `LUtarjet' with video. Precise measurements of the coracoid process, glenoid deficiency and osteotomy plane were made preoperatively. Only three arthroscopic portals were needed and limit unique coracoid osteotomy was performed with coracoacromial arch preservation. The mini window splitting of the subscapularis was performed from the posterior to the anterior direction and the split window was as small as 8–10 mm in length.ResultsA total of 27 patients (25.6 ± 5.4 years) were included in the study. The average surgical duration was 55.6 ± 6.3 min and the mean follow-up time was 8.1 ± 1.5 months. The functional score was significantly improved at the last follow-up. Radiologic evidence showed that the bone graft healing was placed in the desired position. No complications were found.ConclusionsWe present a fast, easy, accurate, safe arthroscopic ‘LUtarjet’ technique called FEAST that can simplify the arthroscopic Latarjet process and achieve a satisfactory bone graft position and satisfactory short-term clinical outcomes.Level of evidenceIV, case series.

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.

Functional Outcomes Are Similar After Arthroscopic Capsular Repair of Triangular Fibrocartilage Complex Tears Between Outside-In Technique and All-Inside Technique Using Pre-Tied Suture Device

To compare outcomes of arthroscopic triangular fibrocartilage complex capsular repair at 2-year follow-up between outside-in and all-inside techniques. In total, 58 consecutive patients (wrists) with a Palmer 1B triangular fibrocartilage complex tear without symptomatic distal radioulnar joint instability underwent arthroscopic suture repair from 2011 to 2019 including 31 patients via the outside-in technique (group A) and 27 via the all-inside technique using a pre-tied needle device (group B). Two-year follow-up included visual analog scale (VAS) pain score, motion range, grip strength, Mayo Modified Wrist Score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complication rate. Correlation between functional result and patient satisfaction was analyzed. Score changes in VAS, wrist flexion-tension, supination-pronation, grip strength, MMWS, and QuickDASH at 2-year follow-up were not significantly different between group A (3.4 ± 0.8, 18.4 ± 17.5, 12.9 ± 13.3, 30.7 ± 11.2, 26.6 ± 7.9 and 19.4 ± 9.9 and group B (3.4 ± 1.0, 18.5 ± 18.3, 15.6 ± 13.7, 30.8 ± 11.4, 28.1 ± 8.6, and 7.6 ± 7.2) with P values of .400, .489, .223, .486, .240, and .223 respectively. Surgical time averaged 105 minutes (78 to 136) in group A and 94 minutes (61-126) in group B with significant difference (P= .012). Patient satisfaction averaged 1.1 (0-3.5) in group A and 1.0 (range 0-3.0) in group B. Satisfaction score was more strongly correlated with QuickDASH (coefficients: 0.863 in group A and 0.918 in group B) than with MMWS (-0.693 in group A and -0.465), grip strength (-0.619 in group A and -0.417 in group B) and VAS score (0.607 in group A and 0.222 in group B). Both techniques achieved comparable outcomes with shorter surgical time in all-inside repair using pre-tied needle device. Patient satisfaction was strongly correlated with QuickDASH score. Level III, retrospective therapeutic comparative investigation.

Long-term outcomes of arthroscopic suture fixation for anterior cruciate ligament tibial avulsion fracture

Introduction: Anterior cruciate ligament (ACL) tibial avulsion fracture is one of the most common knee injury. There are many classical procedures to be available for fixation ACL tibial avulsion fracture. Nowaday, arthroscopic suture fixation for ACL tibial avulsion fracture has many advantages and limits complications effecting knee joint. Objective: To evaluate long-term outcomes of arthroscopic suture fixation for anterior cruciate ligament tibial avulsion fracture. Subject and method: Thirty six patients with ACL tibial avulsion fracture (types II, III, IV), mean age of 33.8 years (range from 22 to 46 years) were prospectively followed up after arthroscopic suture fixation for anterior cruciate ligament tibial avulsion. Along with clinical examination, radiographs, Lysholm score, IKDC classification were used to evaluate the patients. Anteroposterior knee laxity was measured with a KT-1000. Result: Patients were followed up for a mean of 14.46 months (range, 6 to 24 months). At final follow-up, the mean Lysholm score was 92 (range, 81 to 100). 34 patients (94.5%) were classified by IKDC score as normal or nearly normal (grade A or B). The IKDC classification was abnormal (grade C) in 2 patients (5.6%). Anterior translation of the tibia, measured with the KT-1000, was 1.69mm on average (range, 0 to 6mm) compared to the healthy side. All 36 fractures achieved union within 3 months. Conclusion: Treating ACL avulsion fracture with arthroscopic suture fixation can restore ACL length, stabilize fragments, promote early motion.

Does the immediate repair of Bankart lesion following first dislocation reduce the chances of recurrence after arthroscopic repair in soldiers?

The study attempted to compare the effects of immediate and delayed arthroscopic Bankart repair on the shoulder dislocation recurrence. In total, 465 soldiers with first-time anterior shoulder dislocation were included in the study. Of the total, 285 soldiers underwent a quick arthroscopic Bankart repair procedure, whether 180 soldiers underwent a delayed repair procedure. The initial dislocation was traumatic in both groups and operated using the standard arthroscopic suture anchor repair technique. Patient's age, repair time since the first dislocation, number of dislocations before surgery, number of suture anchors used during the repair, duration of surgical procedure, duration from surgery to return to work, and recurrence of dislocation after surgery were recorded. Rowe score, Constant score, and American Shoulder and Elbow Surgeons score were used for clinical assessment. The operating time and recurrence rate were higher in the group subjected to delayed repair procedure than in the group subjected to immediate repair procedure. Repair timing was found to be crucial for a successful outcome. The findings suggest that Bankart repair must be performed immediately to minimize recurrence and other degenerative changes, which may require an additional surgical procedure for satisfactory repair. More studies are required to reach a definitive conclusion. Level III.

Comparative outcomes between all-inside arthroscopic suture anchor technique versus arthroscopic transosseous suture technique in patients with triangular fibrocartilage complex tear: a retrospective comparative study

BackgroundTriangular fibrocartilage complex (TFCC) has become an interest over the last few decades, discovering its understanding in anatomy, pathomechanism, biomechanics, and management in treatments. Currently, TFCC does not have a golden standard procedure, and not one surgical procedure is superior to the other. This study is to evaluate the comparative outcomes in TFCC patients that underwent either in all-inside arthroscopic suture anchors or the arthroscopic transosseous suture technique.MethodFrom 2017 to 2019, 30 patients were analyzed. Eight patients were in an arthroscopic transosseous group and 22 patients were in an all-inside arthroscopic group. Comparison between patients’ flexion and extension range of motion (ROM), grip strength, and visual analog pain scale (VAS) preoperative and six-month follow-up were analyzed.ResultThere were significant increases in flexion ROM, extension ROM, and VAS between preoperative and postoperative in all-inside arthroscopic and arthroscopic transosseous. Only the all-inside arthroscopic group had a significant increase in grip strength. Postoperative flexion ROM had a significant difference between all-inside arthroscopic and arthroscopic transosseous.ConclusionBoth the all-inside arthroscopic suture anchor technique and the arthroscopic transosseous suture technique are appropriate treatments to treat patients with TFCC. Both procedures have achieved the ultimate goal of improved longevity and optimal function.Level of evidenceLevel III; retrospective comparative cohort study.

Arthroscopic Two-Point Suture Bridge Fixation Technique for the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fractures

This study aimed to present and evaluate a new arthroscopic technique that uses two-point suture fixation for anterior cruciate ligament (ACL) tibial avulsion fractures. A total of 15 patients diagnosed with ACL tibial avulsion fracture underwent arthroscopic suture fixation from November 2018 to October 2019 and were treated using two-point suture fixation. The patients were followed up and evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, Tegner activity level scales, anterior drawer testing, and KT-1000 arthrometer testing. The mean follow-up period was 18 months (12 to 24). All patients had a negative Lachman test and anterior drawer test at final follow-up and showed the radiological union of avulsion fracture at 12-week postoperative radiograph. The Lysholm score improved significantly postoperatively with a mean score of 94.26±3.63 (87 to 98; p &lt; 0.001). The Tegner score improved significantly postoperatively from 3.61 ±1.37 to 7.14±1.51 (P &lt; 0.001). The KT-1000 measured value decreased significantly postoperatively from 7.3±1.5 to 1.4 ±1.2 (P &lt; 0.001). The IKDC category was abnormal or severely abnormal preoperatively, and all patients improved to normal or nearly normal at final follow-up. Arthroscopic treatment using the two-point suture fixation technique is effective for ACL avulsion fracture and can restore the function and stability of the knee joint.

Clinical oberservation on rotator cuff suture threader and strapping suture in meniscus tear under arthroscopy

To explore clinical effect of arthroscopic meniscus tear strapping suture by rotator cuff suture threader. Forty patients with meniscus tear injury admitted from July 2015 to May 2019, including 27 males and 13 females, aged from 20 to 55 years old with an average of (36.0±1.4) years old. Menisci laceration was sutured with rotator cuff suture thread under arthroscopy. Postoperative complication was observed, Lysholm knee joint score before and after operation at 12 months were used to evaluate clinical effects, visual analogue scale (VAS) and range of knee flexion and extension were applied to evaluate recovery of pain and function. All patients were followed up from 12 to 15 months with an average of (12.6±0.7) months.No complication such as joint effusion, suture failure occurred. Two patients occurred mild pain after activity without clinical physical abnormality, and 1 patient manifested moderate pain with joint space tenderness, the other rest without abnormal. Lysholm knee joint score was increased from (49.55±1.21) preoperatively to (98.95±0.42) at 12 months after operation, VAS score decreased from (5.18±0.78)preoperatively to (1.03±0.77) at 12 months after operation, and range of knee joint flexion and extension activity increased from (50.63±9.20)°preoperatively to (130.38±4.99)°after operation, and there were statistical differences in Lysholm knee joint score, VAS and range of knee joint flexion and extension activity (P< 0.05). Arthroscopic strapping suture by rotator cuff suture threading device applies to most meniscus injuries, including medial meniscus posterior horn tears, lateral meniscus body tears and lateral meniscus posterior horn tears. This technique meets the need of full-internal meniscus suture without specialmeniscus suture, and has advantages of convenient operation, less complications and good postoperative function.

Arthroscopic All-Inside Suture Bridge for Remplissage Procedure Treating Off-Tracking Hill–Sachs Lesions in Anterior Shoulder Instability

Hill–Sachs lesions are significantly correlated with recurrent anterior shoulder instability. The remplissage procedure is designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterosuperior capsule in patients with off-track Hill–Sachs lesions. This Technical Note describes an arthroscopic all-inside suture bridge to gain more footprint contact area and tissue compression to improve healing. Moreover, it does not have the necessity of going through the subacromial space to retrieve and tie the sutures. Thus, the procedure reduces the operative time and improves reproducibility.

Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes

Background: Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected. Purpose: To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff. Results: The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively (P < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively (P < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%. Conclusion: Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.

Tibial Spine/Eminence Fracture–Suture Fixation

Tibial eminence fractures are a bony avulsion of the anterior cruciate ligament (ACL) tibial insertion. They most commonly occur in pediatric patients, and anatomic reduction with stable fixation are important for good outcomes following surgical treatment. Fracture reduction can be performed via open or arthroscopic surgical techniques and stability can be achieved via screw or suture fixation. This video demonstrates specific techniques, technical tips, and pearls for arthroscopic suture fixation of tibial eminence avulsion fractures.