Double-row Suture-bridge Technique Research Articles

Arthroscopic Stabilization of Osteochondral Fracture of the Anterior-Inferior Glenoid Using Double-Row Suture Bridge Technique

Osteochondral fracture of the glenoid can be caused by traumatic damage in the shoulder, and addressing this injury can be challenging due to the complexity of the condition and the various treatment options. Left untreated, this injury can lead to post-traumatic arthritis and shoulder instability. There have been different surgical techniques for addressing osteochondral fracture, including open and arthroscopic methods, such as debridement, screw fixation, and bone graft, but there is a lack of a universally accepted treatment guidelines. In this technical note, the authors introduce a simple stabilization method for an osteochondral fracture of anterior-inferior glenoid using double-row suture bridge technique through trans-subscapularis portal created by an “inside-out” technique.

Arthroscopic transosseous anchorless rotator cuff repair reduces bone defects related to peri-implant cyst formation: a comparison with conventional suture anchors using propensity score matching.

The transosseous anchorless repair (ToR) technique was recently introduced to avoid suture anchor-related problems. While favorable outcomes of the ToR technique have been reported, no previous studies on peri-implant cyst formation with the ToR technique exist. Therefore, this study compared the clinical outcomes and prevalence of peri-implant cyst formation between the ToR technique and the conventional transosseous equivalent technique using suture anchors (SA). Cases with arthroscopic rotator cuff repair (ARCR) between 2016 and 2018 treated with the double-row suture bridge technique were retrospectively reviewed. Patients were divided into ToR and SA groups. To compare clinical outcomes, 19 ToR and 57 SA cases without intraoperative implant failure were selected using propensity score matching (PSM). While intraoperative implant failure rate was analyzed before PSM, retear rate, peri-implant cyst formation rate, and functional outcomes were compared after PSM. The intraoperative implant failure rate (ToR, 8% vs. SA, 15.3%) and retear rate (ToR, 5.3% vs. SA, 19.3%) did not differ between the two groups (all P>0.05). However, peri-implant cysts were not observed in the ToR group, while they were observed in 16.7% of the SA group (P=0.008). Postoperative functional outcomes were not significantly different between the two groups (all P>0.05). The ToR technique produced comparable clinical outcomes to conventional techniques. Considering the possibility of additional surgeries, the absence of peri-implant cyst formation might be an advantage of ToR. Furthermore, ToR might reduce the medical costs related to suture anchors and, thereby, could be a useful option for ARCR.

Effectiveness analysis of arthroscopic single/double-row suture techniques in repairing of moderate rotator cuff tears

To compare the early effectiveness of arthroscopic repair of moderate rotator cuff tears with single-row modified Mason-Allen technique and double-row suture bridge technique. The clinical data of 40 patients with moderate rotator cuff tears who met the selection criteria between January 2021 and May 2022 were retrospectively analyzed. Among them, 20 cases were repaired with single-row modified Mason-Allen suture technique (single-row group) and 20 cases with double-row suture bridge technique (double-row group). There was no significant difference in gender, age, disease duration, rotator cuff tear size, and preoperative visual analogue scale (VAS) score, Constant-Murley score, and T2* value between the two groups ( P>0.05). The VAS score, Constant-Murley score (including subjective influence, pain, flexion, internal rotation, external rotation, abduction, and muscle strength score) were compared between the two groups before operation and at 6 weeks, 3, 6, and 12 months after operation. Functional MRI and ultrashort-echo-time (UTE)-T2* technique were performed to calculate T2* value and quantitatively evaluate the healing of rotator cuff tissue; and the healing of rotator cuff was evaluated by Sugaya classification at 12 months after operation. Patients in both groups were followed up 1 year. There was no complication such as muscle atrophy, joint stiffness, or postoperative rotator cuff tear. The intra-group comparison showed that the scores of pain, subjective influence, flexion, abduction, and muscle strength in Constant-Murley scores at each time point after operation in the two groups were significantly higher than those before operation, while VAS scores were significantly lower than those before operation ( P<0.05). Internal rotation, external rotation, and total score of Constant-Murley score in the two groups were lower at 6 weeks due to abduction immobilization within 6 weeks after operation, and gradually increased at 6 months after operation, with significant differences at 3, 6, and 12 months after operation when compared with those before operation and at 6 weeks after operation ( P<0.05). The T2* values of the two groups showed a downward trend over time, and there were significant differences between the two groups at other time points ( P<0.05), except that there was no significant difference between at 6 and 12 months after operation in the single-row group and between at 3, 6, and 12 months after operation in the double-row group ( P>0.05). The comparison between groups showed that the VAS score and T2* values of the double-row group were significantly lower than those of the single-row group at 6 weeks, 3 months, 6 months, and 12 months after operation ( P<0.05). The scores of subjective influence, flexion, abduction, and internal rotation in the double-row group were significantly better than those in the single-row group at 6 weeks and 3 months after operation ( P<0.05), and the external rotation score and total score in the double-row group were significantly better than those in the single-row group at 3 months after operation ( P<0.05), but there was no significant difference at 6 and 12 months after operation ( P>0.05). There was no significant difference in muscle strength and pain scores between the two groups at 6 weeks, 3 months, 6 months, and 12 months after operation ( P>0.05). There was no significant difference in the results of Sugaya classification between the two groups at 12 months after operation ( Z=1.060, P=0.289). The effectiveness of arthroscopic repair of moderate rotator cuff tears with modified Mason-Allen technique and double-row suture bridge technique is satisfactory, but suture bridge technique is helpful to the early rehabilitation training of shoulder joint and the recovery of motor function of patients.

Comparison of clinical efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in the treatment of huge rotator cuff injury

Objective: To compare the postoperative efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in treating huge massive rotator cuff injury. Methods: The clinical data of 74 patients with unilateral massive rotator cuff injury admitted to Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University, from January 2019 to September 2021 were retrospectively analyzed. There were 39 males and 35 females, aged (60.2±7.8) years (range: 42 to 77 years). During operation, 44 patients were treated with single double-row suture bridge technique (the simple group), and 30 patients were treated with double-row suture bridge technique combined with type Ⅱ "Chinese way" treatment (the combined group). In the simple group, only internal and external row anchors were used to fix the fractured rotator cuff, while in the combined group, the biceps long head tendon was first transposed to the footprint area and fixed with an internal row anchor tail thread, and then the remaining rotator cuff fracture was repaired with double-row suture bridge technique. The operation conditions were recorded. The range of motion of shoulder joint, visual analogue scale (VAS), American Society for Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley shoulder joint score before operation, 6 months after operation and at the last follow-up were compared between the two groups. Postoperative complications and imaging results were recorded. The difference values of each observation index before and after operation were calculated. The repeated measures analysis of variance was used for repeated measurement data, and LSD multiple comparison method was used for the data at different time points in the two groups. Results: All the patients successfully completed the operation, and no serious complications occurred during or after operation. The patients were followed up for (14.6±5.4) months (range: 6 to 24 months). In all patients, the shoulder range of motion, VAS, ASES score, UCLA score and Constant-Murley shoulder score at 6 months after operation and at the last follow-up were significantly improved compared with those before operation (all P<0.01), and the results at the last follow-up were also better than those at 6 months after operation (all P<0.01). The results of the combined group at 6 months after operation and at the last follow-up (all P<0.01) were better than those of the single group. At 6 months after operation and at the last follow-up, the anteroposternal X-ray showed no significant progress in the degeneration of shoulder joint. Of the 27 patients who completed MRI during follow-up, 14 patients re-injured of reconstructed rotator cuff tissue (type Ⅳ and type Ⅴ) was found in 14 cases, the incidence was 22.7% (10/44) in the simple group and 13.3%(4/30) in the combined group. There was no significant difference between the two groups(χ2=1.026, P=0.311). Conclusion: Compared with the simple double-row suture bridge technique, the method of double-row suture bridge technique combined with type Ⅱ "Chinese way" for repairing massive rotator cuff injury has better effect on improving the short-term pain symptoms, joint range of motion, restoring joint function, and has lower incidence of complications.

Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up.

The clinical outcomes following surgical management of insertional Achilles tendinopathy (IAT) vary depending on the surgical technique used to reattach the Achilles tendon following debridement. The aim of this study was to investigate the clinical outcomes of patients with IAT who underwent surgical management with a double-row suture bridge technique used to reattach the Achilles tendon. A retrospective review of consecutive patients diagnosed with IAT, who underwent surgical management utilising a double-row suture bridge technique (Arthex Speedbridge), and a minimum of 3-month follow-up were included. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) Index score which is a patient reported outcome measure (PROM). Secondary outcomes included EuroQol EQ-5D-5L health-related quality of life PROM and complication rates. Between July 2013 and June 2020, 50 consecutive patients (23 male; 27 female) were included. The mean age (± standard deviation) was 52.3 ± 11.3 (range 29.0-84.3). Pre- and post-operative PROM data were available for all cases. The mean follow-up was 2.4 ± 1.9years. The MOXFQ Index score improved from 48.5 to 12.4 (p < 0.01), EQ-5D-5L improved from 2.7 ± 0.46 to 1.2 ± 0.37 (p < 0.01), and EQ-VAS improved from 48.0 ± 18.4 to 84.1 ± 12.6 (p < 0.01). Four patients had complications which were of minimal clinical relevance and caused no deviation from routine recovery. There were no cases of tendon rupture. This study has demonstrated that surgical management of IAT is safe and effective with clinical improvement in both clinical and general health-related quality of life outcome PROMs. IV.

All-Suture and Solid Medial Row Anchors Produce Similar Clinical Outcomes for Double Row Suture Bridge Rotator Cuff Repair (227)

Objectives:All-suture anchor use for rotator cuff repair is increasing. Potential benefits of these anchors include less bone loss from anchor hole drilling and decreased injury to the chondral surface with anchor pullout. Minimal evidence exists comparing clinical outcomes of all suture to solid medial row anchor fixation in double row suture bridge rotator cuff repair. The purpose of this study was to compare patient-reported outcomes for rotator cuff tears treated with all-suture medial row anchors to those treated with more traditional solid anchors. The null hypothesis was that there is no difference in outcomes between the all-suture and solid anchor rotator cuff repairs.Methods:Three sports medicine fellowship trained surgeons performed rotator cuff repairs using the double row suture bridge technique with minimum 3 years of follow up. Patients were separated into two groups based on whether or not they received all-suture or solid anchor fixation for the medial row of their repair. All lateral row fixation was performed with solid anchors. Primary outcomes were evaluated with telephone follow-up and included the American Shoulder and Elbow Surgery Score (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS). The Rehabilitation protocol was the same for all subjects in the study.Results:3 sports medicine fellowship trained orthopaedic surgeons performed 153 rotator cuff repairs. 91 of these subjects had all-suture fixation of the medial row and 62 received solid anchor fixation. Follow up was 3.6 years ± 0.6 for the all-suture group and 3.7 years ± 0.6 in the solid anchor group (p= 0.28). ASES scores were 92 ± 16 in the all-suture group and 90 ± 17 in the solid group (p =0.35). SANE scores were 91 ± 13 in the all-suture and also 91 ± 13 in the solid anchor cohort (p = 0.97). VAS scores were 1.1 ± 2.0 in the all-suture and 0.7± 1.8 in the solid anchor group (p=0.17). There were no significant differences between groups with regards to re-operation rate or anchor configuration.Conclusions:All suture anchors used in medial row fixation for double row suture bridge rotator cuff repairs have similar clinical outcomes to rotator cuff tears treated in similar fashion with solid medial row anchors.

How to Maximize Suture Tension in Double-Row Suture-Bridge Rotator Cuff Repair?

Double-row suture-bridge technique for rotator cuff repair has been used for rotator cuff tears. In large tears that require 2 or more lateral row anchors, loosening of the suture bridges could occur because of tightening sequence. By retightening suture limbs before deploying the first lateral row anchor, premature loosening could be prevented and enhance the tension of the construct.

Arthroscopic Excision of Infraspinatus Calcific Tendinitis With Double-Row Margin Convergence Repair

Calcific rotator cuff tendinitis is a common cause of shoulder pain. It is thought to be an active cell-mediated process although the exact pathophysiology remains unclear. It commonly affects the supraspinatus tendon. The condition is generally self-limiting and can be managed with appropriate nonoperative treatment; however, some cases may need surgical excision. Complete removal of the calcific deposits may result in large significant defects. Infraspinatus calcific deposits were seldomly described. This report illustrates a double-row suture bridge technique with margin convergence of a large cuff defect after excision of calcific deposits within the infraspinatus tendon.

Arthroscopic repair of the medium-size rotator cuff tear with the novel technique of the point union bridge: a minimum 2-year follow-up cohort study.

Achieving secure fixation and preventing retear have been recognized as fundamental in arthroscopic repair of rotator cuff tears. Moreover, reducing internal implantation can lower medical expenses and minimize the operation time, which is essential for the surgical safety and postoperative rehabilitation of the patients. We have recently proposed the point union bridge (PUB) suture configuration as a novel method for not only providing equivalent fixation but also decreasing the operation time and medical expenses. However, no comparative clinical studies have been performed. From March 2014 to September 2016, a total of 88 patients with diagnoses of medium-size rotator cuff tears underwent arthroscopic repair with a randomly assigned technique-either the PUB technique (n = 42) or the double-row suture bridge (DRSB) technique (n = 46). All patients underwent a minimal 2-year follow-up. We used the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, active and passive range of motion, and visual pain-simulation score (visual analog scale [VAS] score) to assess the functional outcomes. In addition, we recorded the arthroscopic operation time, medical costs, and postoperative complications. All patients received magnetic resonance imaging at the 6-month and 2-year postoperative evaluations to assess structural integrity and tendon healing. At the 2-year follow-up, all scoring parameters evaluated (CMS, ASES score, and VAS score), as well as active and passive range of motion, improved significantly in both groups as compared with preoperative assessments. The PUB technique significantly decreased the operation time (55.9 ± 14.1 minutes vs. 72.2 ± 14.2 minutes for PUB vs. DRSB, P < .001) and medical expenses ($2608.0 ± $391.1 vs. $4056.9 ± $350.9 for PUB vs. DRSB, P < .001). However, no significant differences between the 2 techniques were found in any functional assessments of the shoulder (CMS, ASES score, and VAS score), repair integrity, or the retear rate at the 2-year follow-up. Arthroscopic repair of the medium-size rotator cuff tear with either the PUB or DRSB technique could yield both satisfactory improvements in the shoulder function of patients and equivalent tendon integrity. With less consumption of internal implants, the PUB technique significantly reduced the operation time and decreased medical expenses.

Arthroscopic repair with footprint ending shift for massive rotator cuff tear

To investigate the method and clinical effects of arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear. From March 2015 to April 2019, 27 patients with massive rotator cuff tear underwent arthroscopic repair, including 12 males and 15 females, ranging in age from 37 to 74 years old, with an average age of (56.1±8.9) years. According to the tension of rotator cuff, 5 patients were treated with double row suture bridge technique, and 22 patients were treated with single row technique, among which 7 patients underwent partial rotator cuff repair. Before and after operation, University of California Los Angeles(UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) were used to evaluate shoulder joint function. All the patients were followed up, and the duration ranged from 8 to 40 months, with an average of (18.0±5.9) months. The UCLA score increased from preoperative 8.67±0.78 to final follow-up 30.89±1.07(t=43.56, P<0.001);ASES score increased from preoperative 8.56±0.67 to final follow-up 12.63±0.33(t=15.28, P<0.001);and the VAS decreased from preoperative 6.00(5.00 to 7.00) scores to final follow-up 0.00 (0.00 to 2.00) scores (Z=-4.56, P<0.001). Three patients could not lift the shoulder above the head, without pain. The symptom had no effects on daily work and life, 2 of these patients underwent partial rotator cuff repair. Arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear has satisfactory results, and single-row can be chosen to completely or partial repair rotator cuff tear for most patients.

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;

Arthroscopic Rotator Cuff Repair: Double Row Suture Bridge Technique (About 50 Cases)

Rotator cuff tear occurs in young adults as a result of degenerative and/or traumatic tendon pathology. This retrospective study presents outcomes in 50 patients who had undergone arthroscopic rotator cuff repair. This work has shown that the double row suture bridge technique seems to be more anatomical. By applying the tendon on the previously prepared footprint which is located in the greater tuberosity and thus restoring the tendons to their approximate premorbid positions, which significantly improves the patient’s quality of life.

Osteolysis is observed around both bioabsorbable and nonabsorbable anchors on serial magnetic resonance images of patients undergoing arthroscopic rotator cuff repair

ObjectivesThe objective of this study was to evaluate the incidence of osteolysis around the bioabsorbable and nonabsorbable anchors using serial magnetic resonance imaging (MRI) and to determine the relationship between osteolysis and the retear rate after arthroscopic rotator cuff repair. MethodsFrom July 2012 to July 2014, 50 patients [28 men and 22 women; mean age, 56.4 (range: 45–56) years] underwent arthroscopic rotator cuff repair for a medium-to large-size tear with double-row suture-bridge technique. The bioabsorbable anchors used in the medial row comprised hydroxyapatite-polylactic acid enantiomer, and the nonabsorbable anchors in the lateral row were polyetheretherketone (PEEK)-type anchors. All patients underwent MRI evaluation at 3, 6, and 12 months postoperatively to determine osteolysis and identify any retear. ResultsThe incidences of osteolysis at 3, 6, and 12 months postoperatively were 1%, 4%, and 6% with nonabsorbable anchors and 13%, 29%, and 39% with bioabsorbable anchors, respectively. The incidences of osteolysis were significantly higher with the bioabsorbable anchors than with the nonabsorbable anchors (P < 0.005 for all three follow-ups). There was no significant difference between osteolysis and non-osteolysis groups regarding the retear rate or retear size (P = 0.189 and 0.069, respectively). ConclusionsOsteolysis was common around bioabsorbable anchors used for arthroscopic rotator cuff repair, and it also occurred around the PEEK-type nonabsorbable anchors. The incidence of osteolysis of nonabsorbable anchors was significantly lower than that of bioabsorbable anchors. Osteolysis did not significantly affect rotator cuff retear after arthroscopic repair with either bioabsorbable or nonabsorbable anchors. Level of evidenceLevel III, Therapeutic Study.

Arthroscopic Rotator Cuff Repair With a Knotless Suture Bridge Technique: Functional and Radiological Outcomes After a Minimum Follow-Up of 5 Years

To evaluate clinical and radiological outcomes of knotless suture bridge repair after a minimum of 5years of follow-up. A prospective consecutive series of full-thickness supraspinatus atraumatic chronic tears was evaluated in the study. Tears were medium or large. Further inclusion criteria were minimum clinical follow-up of 5years with magnetic resonance imaging (MRI) at 24months and fatty infiltration <2. Patients with shoulder stiffness, arthritis, or rotator cuff tear involving the subscapularis tendon were excluded. An arthroscopic cuff repair was performed using a knotless double-row suture bridge technique with braided suture tapes. Clinical outcomes were evaluated using the Constant score, the American Shoulder and Elbow Surgeons score, strength score, and a visual analog scale. Tendon healing was analyzed according to Sugaya MRI classification at 24months. A Sugaya score of 1 or 2 was considered as tendon healing. Statistical analysis was performed with the Student's t-test. P= .05 were considered statistically significant. Sixty-eight patients were included in this series. Mean follow-up was equal to 68.8 ± 7months. At last follow-up, the mean visual analog scale, American Shoulder and Elbow Surgeons score, and Constant scores improved significantly from 5.5 ± 1.6, 48.2 ± 13.1, 37.8 ± 8.3, to 2.1 ± 2.1 (P= 5.43 E-14), 87.4 ± 15.8 (P= 7.15 E-27), and 82.8 ±14.7 (P= 1.01 E-33), respectively. Anteflexion improved from 99.3° ± 13.4° preoperatively to 136.6° ± 15.9° at last follow-up (P= 3.08 E-21). Strength score was significantly higher postoperatively (18.4 ± 6.7 vs 8.3 ± 3.5). MRI showed 88% (n= 57) of Sugaya 1-2 repairs. Patients with unhealed rotator cuffs showed significantly lower functional results than the Sugaya 1-2 group. No correlation between degree of retraction and rate of healing was observed. Four symptomatic patients (6%) required revision for failed rotator cuff repair. Despite potential confounding factors, arthroscopic knotless suture bridge repair of rotator cuff tears with acromioplasty demonstrated excellent long-term results of tendon healing, pain relief, and improvement of shoulder function. Level IV, therapeutic case series.

Arthroscopic Repair of the Isolated Subscapularis Full-Thickness Tear: Single- Versus Double-Row Suture-Bridge Technique

Background: No clinical comparative study has addressed isolated subscapularis tears after arthroscopic repair with either single-row or double-row suture-bridge technique. Purpose/Hypothesis: The purpose of this study is to compare clinical outcomes and structural integrity after arthroscopic repair of an isolated subscapularis full-thickness tear with either the single-row technique or the double-row suture-bridge technique. The authors hypothesized that there would be no significant differences in clinical outcomes and structural integrity between approaches. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 56 patients who underwent arthroscopic repair of an isolated subscapularis full-thickness tear with grade II or less fatty infiltration in the subscapularis muscle with either a single-row technique (n = 31) or a double-row suture-bridge technique (n = 25). Functional outcomes were assessed with the visual analog scale (VAS) for pain, Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, and active range of motion. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6 months after surgery to assess the structural integrity of the repaired tendon. Results: At the 2-year follow-up, all scoring parameters applied (VAS, SSV, ASES, and UCLA), subscapularis strength, and active range of motion improved significantly in both groups as compared with preoperative values (P < .001). However, there were no significant differences between groups in any of these clinical outcome measurements (VAS, 1.2 vs 1.1; SSV, 91.3 vs 91.8; ASES, 91.0 vs 91.4; UCLA, 31.9 vs 32.1). On follow-up MRA or CTA, the overall retear rate did not differ significantly between the single-row group (13%, 4 of 31) and the double-row group (12%, 3 of 25). Conclusion: Arthroscopic single-row repair and double-row suture-bridge repair of isolated full-thickness subscapularis tears both yielded satisfactory clinical outcomes and structural integrity with no significant differences among patients with good muscle quality.

Comparison of Structural Integrity and Functional Outcome Between Delaminated and Nondelaminated Rotator Cuff Tears After En Masse Arthroscopic Repair: A Retrospective Cohort Study With Propensity Score Matching

Background: Arthroscopic repair of delaminated rotator cuff tears (RCTs) has shown poor prognoses. Despite the importance of delaminated tears, only a few studies have compared delaminated and nondelaminated tears. Purpose: This study aimed to compare the clinical outcomes and structural integrity after en masse arthroscopic rotator cuff repair between delaminated and nondelaminated RCTs and to evaluate whether infraspinatus tendon involvement affects the prognosis for delaminated tears after arthroscopic cuff repair, through use of propensity score matching for precise comparison. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 180 consecutive patients with medium- or large-sized RCTs who had an arthroscopic rotator cuff repair with a minimum 2-year follow-up, of whom 57 and 123 had delaminated tears (group 1) and nondelaminated tears (group 2), respectively. The en masse repair technique using a single-row or transosseous-equivalent double-row suture-bridge technique was used for of all the delaminated cases. Preoperative and postoperative visual analog scale pain scores, shoulder active range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Constant scores were assessed. Magnetic resonance imaging was performed at least 24 months postoperatively to identify retear of the repaired rotator cuffs. After propensity score matching, 32 cases in both groups were successfully matched, and the clinical and radiological results were analyzed. Results: Before propensity score matching, postoperative clinical outcomes were improved, showing no significant differences between the groups, excluding forward elevation (P = .011). Groups 1 and 2 had 17 (29.8%) and 11 retear cases (8.9%), respectively (P < .001). After propensity score matching, only the ASES score (72.5 vs 77.1) showed a significant superiority in group 2 (P = .038). Propensity-matched groups 1 and 2 had 8 (25.0%) and 2 (6.3%) retear cases, respectively (P = .034). No significant difference was found in structural integrity depending on whether the RCT included the infraspinatus tendon (IST). The odds ratio for retear of the delaminated tears, including IST, was 5.5 (95% confidence interval, 1.0-30.0, P = .038). Conclusion: Delaminated RCT was a negative prognostic factor of structural integrity after repair and could affect the functional outcome. However, whether IST tear was involved had no effect on the prognosis after repair.

Arthroscopic en masse repair with footprint ending shift using double-row suture-bridge technique for delaminated rotator cuff tears under tension

Objective To analyze the clinical effects of arthroscopic en masse repair with footprint ending shift using double-row suture-bridge technique for delaminated rotator cuff tears under tension. Methods A total of 58 patients with delaminated rotator cuff tears under tension from August 2013 to August 2016 who underwent arthroscopic en masse repair using double-row suture-bridge technique were retrospectively analyzed. There were 33 males and 25 females with a mean age of 53.0±7.8 years (range 39-74) with 24 patients left side involved and 34 right side. They were divided into 2 groups to receive en masse repair either footprint ending shift or on the footprint. There were 28 patients with footprint ending shift and 30 patients on the footprint. Clinical effects were evaluated by University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), Constant-Murley score and shoulder range of motion at preoperatively and postoperatively. Results The average follow-up duration was 23.2±0.8 months (range 21-24). The two groups were compatible with no significant difference in age, gender, tear size, follow-up duration, preoperative function and range of motion of the shoulder joint (P>0.05). At the last follow up, the UCLA, ASES, VAS, Constant-Murley scores and shoulder range of motion in the group footprint ending shift were respectively 32.4±2.5, 12.8±0.9, 1.0±1.1, 93.4±5.6, 158.3°±9.3°, 58.9°±5.0° with significantly differences compared with preoperative scores (P 0.05). The operation duration in the group footprint ending shift was 100.9±6.0 min, while that in the group on footprint was 106.6±6.1 min. There was significantly difference in the operation duration between two groups (t=-3.600, P=0.001). Conclusion Arthroscopic en masse repair using double-row suture-bridge technique can successfully treat delaminated rotator cuff tears under tension. Compared with arthroscopic en masse repair on footprint using double-row suture-bridge technique, the footprint ending shift is easier and time saving without significant difference in function of the shoulder joint and the range of motion in repair of delaminated rotator cuff tear under tension. Key words: Shoulder; Wounds and injuries; Arthroscopy; Reconstructive surgical procedures

A new knotless transosseous suture bridge equivalent suture configuration for mini-open large-to-massive rotator cuff tear repair

Introduction: Repair by arthroscopic double-row suture bridge technique is widely accepted modality of treatment for repairable large-to-massive rotator cuff tears. Repair by mini-open approach has also shown comparable results in such cases. Double-row repair either by mini-open or by arthroscopic approach imposes substantial financial burden on patients belonging to economically deprived & uninsured group. Surgical Technique: We propose a new suture configuration for cuff repair by mini-open approach in which variant of modified Mason-Allen suture technique is used in transosseous manner to provide suture configuration similar to that of suture bridge double-row repair. The knotless nature of the configuration reduces incidence of re-tear that is seen at medial row of the double-row suture bridge repair and the “X” configuration provides large area of contact between the cuff and the footprint which is the advantage of traditional double-row suture bridge repair. Apart from above advantages, this technique is very economical.

Are We Doing Too Many Margin Convergence? A Prospective MRI Study on Re-Tear Rate after Arthroscopic Rotator Cuff Repair

The use of margin convergence, despite helpful to achieve a successful intra-operative complete repair for arthroscopic assisted rotator cuff repair, did not protect the repair from re-tear. Re-tear after successful arthroscopic rotator cuff repair is common. It is notorious that large and massive cuff tear is associated with a lower successful intra-operative complete repair and a higher postoperative re-tear rate. Margin convergence is commonly used to achieve intra-operative complete repair. Despite a very popular technique, the relationship between margin convergence and re-tear after rotator cuff repair is not known. It was hypothesized that there was no difference in the re-tear rate between the repair performed with margin convergence and those without. A prospective study on primary arthroscopic assisted complete repair of full thickness supraspinatus tendon tear using double-row suture-bridge technique was carried out in the author’s institution from 2010 to 2013. 60 repairs were recruited after applying inclusion and exclusion criteria. The follow-up rate at one-year post-operation was 98% and that of two-year was 95%. 50 patients (83%) received reassessment MRI. The repair status was classified according to Sugaya classification. Full thickness re-tear was defined as Sugaya Type IV or V repair. Association of use of margin convergence technique with retear after rotator cuff repair was examined using univariate analysis with Chi square test. The potential association of retear rate and other known patient-related and cuff-related risk factors (including age, DM, active smoking, heavy manual worker, tear size, tear retraction, tear topography in sagittal plane, tear morphology, number of full thickness tendon tear) were examined. Multivariate analysis was then conducted to determine the most significant factor predicting the rate of re-tear. 50 arthroscopic complete repair of full thickness supraspinatus tendon tear using double-row suture-bridge technique with reassessment MRI was studied. The average age was 59 years. 19 were male and 31 were female. Right shoulder was involved in 36 patients. The average follow-up was 37 +/- 13 months. There was 19 full thickness re-tear found on reassessment MRI (11 Sugaya IV and 8 Sugaya V). The incidence was 38%. 10 patients received margin convergence during the repair. The incidence of re-tear after repair with margin convergence was 80% and that without was 28% (p=0.002). The other risk factors identified by univariate analysis to be significantly associated with incidence of re-tear was (1) large and massive tear (p=0.018); (2) increased number of full thickness tendon tear (p=0.03); (3) medial retraction of tear (p=0.001) and (4) Geometric classification of tear morphology (p=0.004). After running mulivariate analysis, the most significant factor predicting re-tear after arthroscopic rotator cuff repair was medial retraction of tendon (p=0.048). The re-tear rate of Patte I, II and III were 24%, 50% and 100% respectively. The incidence of rate of re-tear was significantly higher when margin convergence was used (80% vs 28%, p=0.002). The most important factor predicting rate of re-tear was degree of tear retraction (p=0.048). Despite helping to achieve a successful intraoperative complete repair, the use of margin convergence did not protect the repair in Patte II and III retraction from going into re-tear.

Predictors of Outcomes after Arthroscopic Double-row Rotator Cuff Repair in 155 Cases

Objectives:The purpose of this study was to analyze predictors of clinical outcomes of knotted versus knotless double-row self-reinforcing rotator cuff repairs of full-thickness rotator cuff tears with propensity score matching.Methods:Patients with arthroscopic repair of full-thickness rotator cuff tears involving the supraspinatus tendon using either a knotted or knotless linked, self-reinforcing double-row technique were included in the study. Preoperative subjective evaluation was performed using the ASES and SF-12 PCS scores. After a minimum two-year follow-up period, ASES and SF-12 PCS scores were collected again along with the SANE score, the QuickDASH score, and patient satisfaction. All data were collected prospectively and retrospectively reviewed. Postoperative ASES and SF-12 PCS scores were then modeled using inverse propensity score weighting in a multiple linear regression model (MLR) with multiple imputations. Age, sex, baseline ASES score, length of follow-up, number of anchors, worker’s compensation, previous cuff repair, and double-row repair technique (knotted or knotless) were the covariates used in this model.Results:155 shoulders in 151 patients (109 men, 42 women; mean age at time of surgery 59±10 years) were eligible for inclusion. Outcomes data were available for 130 of 148 shoulders (87.8%) after exclusion of seven shoulders (4.5%) that underwent revision rotator cuff repair before final follow up (n=33/39 in the knotted group [84.6%]; n=97/109 [88.9%] in the knotless group).The mean follow-up was 2.9 years (range, 2.0-5.4 years). Overall, postoperative outcomes scores were significantly improved when compared to preoperative baselines (p<0.05), with a median postoperative ASES score of 97 for the entire cohort. Our model showed that previous rotator cuff repair had a significant negative effect on postoperative ASES (β = -12.7, p<0.001) and SF-12 PCS scores (β = -5.0, p = 0.036). A workers’ compensation claim (β = -10.6, p = 0.007) also had a significant negative effect on postoperative ASES scores. Higher baseline ASES score (β = +0.14, p = 0.025) positively influenced ASES outcomes. Use of a knotless technique also had a positive effect on postoperative scores (β = +2.5, p = 0.235). Age, gender, the length of follow-up and the numbers of anchors did not influence the outcomes (Table 1).Conclusion:Excellent clinical outcomes can be achieved a minimum of two years following arthroscopic repair of full-thickness rotator cuff tears using either the knotted or knotless linked double-row technique. Negative predictors of outcome include low preoperative ASES score, previous rotator cuff repair, and a workers’ compensation claim. Knotless double-row rotator cuff repair had a non-significantly positive effect on the postoperative ASES score compared to the knotted double-row suture bridge technique.