Single-row Rotator Cuff Repair Research Articles

Poster 127: Repairs of Isolated Supraspinatus Tears: Single vs. Double Row Repairs Effect on Patient-Reported Outcomes Over a 2-Year Episode of Care

Objectives: Rotator cuff tears are the most common cause of shoulder disability, most commonly affecting the middle-aged population. Treatment for rotator cuff tears has changed dramatically over the past few decades, with overall volume of rotator cuff repairs (RCRs) increasing by approximately 1.6% each year. Simultaneously, there has been a shift from open, inpatient RCR to arthroscopic, outpatient procedures. Currently, well over 75% of patients undergo arthroscopic repair. The two most common techniques for rotator cuff fixation include single- or double-row fixation. Cadaveric and biomechanical studies demonstrate more complete reduction of the rotator cuff to its original footprint with double row repair, with a subsequent increase in anatomic restoration and biomechanical advantage. Many studies regarding clinical and functional outcomes, however, have not consistently demonstrated statistically significant differences between the two. The purpose of this study is to determine differences in patient-reported outcomes (PROs) after single- and double-row rotator cuff repairs at one and two years postoperatively. We hypothesize that single-row RCR will have noninferior clinical and patient-reported outcomes when compared to the double-row RCR cohort over the 2-year episode of care. Primary outcomes include baseline, 1-year and 2-year postoperative Single Assessment Numeric Evaluation (SANE) scores. Methods: All patients within a single health system that underwent primary rotator cuff repair between 2016 and 2022 were eligible for inclusion in this study. Exclusion criteria included incomplete baseline PROs, involvement of infraspinatus, subscapularis or teres minor tendons, revision surgeries, and concomitant fractures of the shoulder. Demographic information including age, sex, BMI, ASA score, injury characteristics and medical comorbidities were obtained through review of the patients’ electronic medical record. Surgical characteristics and technique were obtained from operative notes. PROs were collected prospectively and stored in a HIPAA-compliant electronic database until retrospective review for this study. Primary outcomes of interest include SANE score at baseline, 1-year and 2-years postoperatively. Secondary outcomes of interest included American Shoulder and Elbow Surgeons (ASES) scores, Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 health questionnaire scores, rates of symptomatic retear and reoperation. Statistical analysis included descriptive analyses, paired t-tests, chi-squared test of independence and one-way ANOVA as appropriate. Statistical significance was defined as an alpha value of p ≤ 0.05. Results: A total of 237 patients met criteria for inclusion in this study, the majority of which were female (122, 51.5%). The average BMI was 30.0 ± 5.6, and the average age of the study participants was 59.0 ± 9.4 years. The majority of patients underwent double-row RCR (134, 56.5%). There were no significant differences in age, BMI, ASA score, gender, or smoking status between the two groups (Table 1). There was a higher observed frequency of diabetes mellitus than expected in the double-row cohort, however this did not reach statistical significance (p = 0.066). There was no significant difference in symptomatic retear, revision RCR, and other reoperation rates between the two cohorts (Table 2). The cohort that received double-row repair had a higher observed frequency of full-thickness tears than expected (p <0.001), however there was no significant difference in the observed frequencies of chronic and acute tears between the two cohorts. Baseline ASES scores did not differ significantly between the two cohorts (p = 0.505). Both cohorts saw statistically significant increase in ASES scores from baseline to 1-year (Figure 1). The difference between 1-year and 2-year ASES scores was less than a quarter of the improvement seen in the first year postoperatively, however, was still statistically significant in the double-row cohort and neared statistical significance in the single-row cohort (p = 0.048 and p = 0.075, respectively). While both cohorts saw significant improvement in ASES scores over the 2-year period, there was no significant difference in score change between the two cohorts. The baseline SANE scores were 40.7 ± 20.6 and 43.2 ± 21.4 for the double and single-row cohorts respectively. Each cohort saw statistically significant increases in SANE scores at 1 year postoperatively and continued to see significant increase between 1- and 2-years postoperatively (Figure 1). There was no statistically significant difference between the two cohorts regarding 1- and 2-year change in SANE scores. Conclusions: Over a 2-year period of care after RCR, patients saw significant improvement in SANE and ASES scores, with the majority occurring in the first year postoperatively. There were no statistically significant differences in patient-reported outcomes between patients that underwent double- and single-row repairs. Single- and double-row RCRs perform comparably over a 2-year episode of care, with excellent clinical and patient-reported outcomes. [Figure: see text]

Arthroscopic repair of large and massive rotator cuff tears-"sandwich augmentation" with the long head of the biceps tendon: a technical note.

For most shoulder surgeons, addressing massive rotator cuff tears that have retracted ends poses a significant challenge. This study introduces a technique, termed the "sandwich augmentation technique," which incorporates the long head of the biceps tendon (LHBT) into a single-row rotator cuff repair. The procedure, performed arthroscopically with the patient in the lateral decubitus position, involves attaching the LHBT and rotator cuff tissues together to the greater tuberosity. This effectively sandwiches them within the rotator cuff footprint. The goal of this technique is to enhance the thickness of the fully interposed cuff margin, thereby providing better support for the repair. The sandwich augmentation technique, which integrates the biceps into the rotator cuff repair, has demonstrated positive clinical outcomes and moderate anatomical results. It also prevents superior migration of the humeral head in cases of large or massive rotator cuff tears. Further research is required to assess the long-term effectiveness of this procedure.

Comparison of Single Dose with Continuous Infusion of 0.2% Ropivacaine in Interscalene Brachial Plexus Nerve Block for Pain Relief in Rotator Cuff Repair Surgery

Background: Severe postoperative pain is the most common complication after arthroscopic rotator cuff surgery. Peripheral nerve blocks, whether single-shot interscalene block (SSISB) or continuous interscalene nerve block, have consistently demonstrated superior analgesia after upper extremity surgery compared to general anesthesia alone. Aims: The aim of this study was to evaluate the difference in pain relief provided by single shot versus catheterized interscalene block. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics of Justice K.S.Hegde Charitable Hospital, Mangalore, from January 2020 to June 2021. Thirty patients who were diagnosed of complete rotator cuff tear were included in the study. All of them underwent arthroscopy-assisted single-row rotator cuff repair by the same surgeon under general anesthesia. They were randomly allocated into Groups I and B of 15 each. Patients in Group A received a SSISB and Group II received continuous infusion after the insertion of catheter. The catheter was removed after 24 h of surgery. Both groups followed the same postoperative management protocol. The pain perception assessment was measured using the Visual Analog Scale (VAS) at 6, 24, 48 h after surgery, and at 2nd week postoperative during suture removal. Power was assessed for the wrist (wrist flexion and extension) and for the fingers (finger flexion and abduction) at 6 h, 24 h, 48 h, and after 2 weeks on day 14 when suture removal was done. The results were calculated and tabulated using an independent “t-test” and “Chi-square test.” Results: The patients in Group A had a higher VAS score with a mean of 0.26 ± 0.06 as compared to Group B which showed a mean VAS score of 0 (P = 0.01). Six patients needed analgesia of postoperative day 2. Eight patients of Group B required rescue analgesia on postoperative day 2. Conclusion: Continuous infusion scalene block was noted to be superior to SSISB in the management of postoperative pain postarthroscopy assisted single-row rotator cuff repair.

Arthroscopic Biceps Tenodesis: Midterm Clinical Results of a New Anchor Suture Technique in Patients with Single-Row Rotator Cuff Repair

Arthroscopic Biceps Tenodesis: Midterm Clinical Results of a New Anchor Suture Technique in Patients with Single-Row Rotator Cuff Repair

Is biceps tenodesis necessary when performing arthroscopic rotator cuff repair in patients older than 55 years?

In patients with arthroscopic rotator cuff repair, tenotomy and tenodesis are the most performed surgical procedures for the biceps long head (BLH) pathologies. Controversy continues as to which surgical procedure provides better results. This study aimed to compare the clinical outcomes of tenotomy and tenodesis applied to the biceps long head in patients who underwent arthroscopic rotator cuff repair. In our study, the clinical results of 706 patients who underwent arthroscopic rotator cuff repair with tenotomy or tenodesis on the long biceps head were evaluated retrospectively. Rotator cuff repair patients were divided into two groups as single-row and double-row repair patients. The clinical results of patients who underwent tenotomy and tenodesis in single-row (n = 383) and double-row (n = 323) repair groups were compared. The clinical outcomes of the patients who underwent tenotomy and tenodesis without distinction between double/single-row repair were also compared. Preoperative and postoperative clinical evaluations of the patients were made with Constant Shoulder Score (CSS) and visual pain scale (VAS). The presence of the Popeye sign in the arm, tenderness in the bicipital groove, and cramping in the biceps muscle in the postoperative period was evaluated and compared among groups. Preoperative and postoperative clinical results of the patients were compared within the groups. A total of 706 patients with a mean age of 61.78 ± 20.94years and a mean follow-up period of 29.15 ± 14.28months were evaluated. The mean age of the tenodesis group (58.13 ± 8.47) was significantly lower than the tenotomy group (61.52 ± 22.58) (p < 0.05). The mean CSS and VAS mean postoperatively in the tenotomy group (n = 587) were 76.84 ± 12.74 and 2.29 ± 2.78. The postoperative mean CSS and VAS in the tenodesis group (n = 119) were 77.56 ± 11.23 and 2.64 ± 2.70. There was no statistically significant difference between the postoperative clinical scores of patients who underwent tenotomy and patients who underwent tenodesis (p > 0.05). There was no difference between the tenotomy and tenodesis groups regarding Popeye deformity (p = 0.980). Bicipital groove tenderness and cramping in the biceps muscle were significantly higher in the tenodesis group (p < 0.001, < 0.001). Tenodesis was performed in 68, and tenotomy was performed in 315 out of 383 patients who underwent single-row rotator cuff repair. Tenodesis was performed in 51, and tenotomy was performed in 272 of 334 patients who underwent double-row rotator cuff repair. When singe versus double-row groups was compared, there was no significant difference in VAS, CSS, Popeye sing, bicipital groove tenderness, or biceps muscle cramping. When tenotomy versus tenodesis was compared within single- and double-row repair groups, there was no significant difference in VAS or CSS. There was no difference between the tenotomy and tenodesis groups regarding Popeye deformity, but bicipital groove tenderness and muscle cramping were more in tenodesis groups regardless of the repair rows. The effect of tenodesis versus tenotomy for BHL pathologies in patients who underwent arthroscopic rotator cuff repair was not significant for clinical scores, but bicipital groove tenderness and biceps muscle cramping were significantly higher in the tenodesis group.

Single Row Rotator Cuff Repair with Triple Loaded Suture Anchors: The SCOI Row Technique

AbstractSince the introduction of rotator cuff repair in the beginning of the 20th century, there have been significant advances in the surgical techniques and improvement in patient outcomes. However, controversy remains regarding the best method for tendon repair, including implant choice, ideal suture construct, and the potential benefits of supplemental biologic additives in order to achieve repair with the best opportunity for healing. The “SCOI Row” technique has been refined over three decades with extensive application and consistently good outcomes. Our technique uses a single row of anchors, triple loaded with a high-strength suture maximizing the number of sutures passed through the tendon to repair the rotator cuff arthroscopically. These anchors are placed 3-4 millimeters from the articular cartilage, providing strong anchorage and a low-tension repair. Debridement of devitalized tendon and only incorporating healthy tendon into the repair is imperative. The biology of the repair is enhanced with bone marrow vents created via microfracture of the greater tuberosity, forming the “Crimson Duvet” or bone marrow super-clot that will envelope the repair site. The bone marrow vents deliver marrow elements, including growth factors and mesenchymal cells that will help to regenerate the footprint of the rotator cuff. This repair construct has been evaluated biomechanically by other investigators and is favorable, as compared to dual row repairs. Our outcomes show greater than 90 % healing rate on postoperative magnetic resonance imaging and excellent patient-reported outcomes.

Clinical Evaluations of Intraoperative Injection of Platelet-Rich Plasma in Arthroscopic Single-Row Rotator Cuff Repair at 2-Year Follow-Up

Background. The clinical evidence is conflicted on whether platelet-rich plasma (PRP) therapies have a positive effect on tendon healing and improved functional outcomes. Purpose. To evaluate the potentials of intraoperative injection PRP on the speed and quality of healing in patients undergoing arthroscopic repair for small to medium rotator cuff tears. Methods. A total of 86 patients scheduled for arthroscopic single-row repair of small to medium rotator cuff tears were assigned to undergo either PRP injection (PRP group) or conventional repair (control group). The PRP group ( N = 43 ) consisted of patients who received an intraoperative injection of liquid PRP. The control group ( N = 43 ) consisted of patients who did not receive that treatment. The visual analogue scale (VAS) for pain before treatment and at 1, 14 days, 3, 6, and 24 months after surgery were recorded. The clinical outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scores before treatment and at 3, 6, and 24 months after surgery and magnetic resonance imaging or ultrasound examination at 24 months. Patient satisfaction and retear rate were also assessed. Results. No statistical differences in baseline characteristics such as age, gender, dominant arm, and tear size were observed between the two groups ( P &gt; 0.05 ). For the PRP group, the mean operation time was 40.22 minutes, and for the control group, the mean operation time was 36.3 minutes. There was a statistically significant difference ( P = 0.036 ). After surgery, all VAS measurements significantly decreased over time until final follow-up in both groups. No significant difference between the 2 groups was found for any VAS pain measurement at any time point except for the VAS at 1 day postoperatively, which was significantly lower in the PRP group ( 2.39 ± 1.03 ) than that in the control group ( 3.21 ± 1.85 ) ( P = 0.014 ). Analysis of the PRP and control groups demonstrated a statistically significant improvement in UCLA and Constant scores from baseline to the 3-, 6-, and 24-month follow-up assessments ( P &lt; 0.05 ). However, no significant intergroup differences were observed in the clinical scores between the three follow-up time points ( P &gt; 0.05 ). At the 24-month follow-up, patient satisfaction rates reached 95.65% and 93.48% for the PRP and control groups, respectively. The retear rate of the PRP group (2/43, 4.65%) was lower than that of the control group (6/43, 13.95%). Conclusions. Although the pain at 1 day after surgery and the retear rate in the PRP group were significantly lower than those in the control group, the liquid PRP injection did not promote better clinical outcomes at the 2-year follow-up.

Anteroposterior tear size, age, hospital, and case number are important predictors of repair integrity: an analysis of 1962 consecutive arthroscopic single-row rotator cuff repairs.

Retear or nonhealing of a surgically repaired rotator cuff is common, but the determinants of retear are poorly understood. We aimed to determine the relationship between preoperative and intraoperative factors and retear rate following rotator cuff repair and to formulate a predictive model based on this relationship, including any interaction effects between tear size, patient age, and surgical experience in contributing to the retear rate. We performed a post hoc analysis of prospectively collected data from 1962 consecutive patients who underwent a primary arthroscopic single-row rotator cuff repair performed by the senior author from 2007 through 2018 and postoperatively returned for 6-month follow-up ultrasonography. Multiple logistic regression analysis revealed anteroposterior tear length to be the most important independent predictor of retear (Wald statistic, 90; P < .001). Other independent predictors included case number (Wald statistic, 59; P < .001), patient age at surgery (Wald statistic, 30; P < .001), and type of hospital (public vs. private) (Wald statistic, 17; P < .001). The data indicated that following rotator cuff repair, there was a 4-fold increase in the retear rate as the anteroposterior tear size increased from 1 cm to 3 cm; a 8-fold decrease when comparing case number 1000 with case number 3000; a 2-fold increase as patient age increased from 50 years to 70 years; and a 3-fold increase when comparing surgery performed in a public hospital vs. a private hospital. The area under the receiver operating characteristic curve was 0.81 (95% confidence interval, 0.78-0.84), indicating that our equation could predict 81% of retears. Anteroposterior tear length was the most important independent predictor of retear or nonhealing. Other predictive factors included case number, patient age at surgery, and hospital type. The predictive effect of anteroposterior tear length, patient age, and case number in contributing to retear was additive. Our regression equation may be used to calculate patient rotator cuff retear risk at 6 months after repair.

Augmentation of rotator cuff repair with gelatin-resorcin-formalin glue: a biomechanical study.

Rotator cuff tendons are typically reattached to the proximal humerus using transosseous sutures or suture anchors. Their primary mode of failure is at the tendon-bone interface. We investigated the addition of an adhesive, gelatin-resorcin-formalin (GRF) glue, to a single-row rotator cuff repair (RCR) on ex vivo sheep models. We hypothesised the addition of GRF glue would increase the repair construct strength. The study consisted of three groups of six sheep infraspinatus tendons with an inverted-mattress stitch, tension-band configuration. Group 1 was the control group where no glue was applied. Group 2 involved applying 2 × 2 cm of GRF glue to the infraspinatus footprint and a 2-min curing time. Group 3 allowed for a 15-min cure time. Failure occurred at the tendon-bone-suture interface in 6/6 of the control group, and 4/6 from groups 2 and 3. Failure occurred via the suture pulling out of the anchor in 2/6 of groups 2 and 3. No significant differences were noted between all three groups in ultimate failure load, repair stiffness or total energy to failure (p > 0.05). The addition of GRF glue to the tendon-bone-suture interface did not enhance RCR strength in an ovine model.

Does change in occupancy ratio and fatty infiltration of the supraspinatus influence functional outcome after single-row rotator cuff repair? A magnetic resonance imaging–based study

The purpose of this study was to analyze the correlation of occupancy ratio (OR) and fatty infiltration (FI) to functional outcome and retear rate following rotator cuff repair by single-row technique. Retrospectively, all the patients (n = 100) with rotator cuff tear were evaluated preoperatively and postoperatively with functional scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], University of California-Los Angeles [UCLA] shoulder score, Constant score) and magnetic resonance imaging (MRI) for ORand FI. Two observers studied the MRI data separately. Statistical analysis was done using SPSS (version 16), paired t test, Pearson correlation, and intraclass correlation coefficients. The mean (± standard deviation) follow-up was 16.24 ± 6.39 months, and the mean age was 56.18 ± 7.5 years. There was a significant increase in muscle atrophy (decreased OR) and FI (P < .01). The mean preoperative and postoperative ORs were 0.57 and 0.51, respectively. However, the mean functional scores improved significantly for ASES (55.78 to 82.09), UCLA (19.44 to 28.47), and Constant score (49.73 to 75.07) (P < .001). There was no significant difference in functional outcome among the different stages of FI (ASES P = .341, UCLA P = .839, Constant P = .376). Seven patients had asymptomatic retear during follow-up, of which 2 patients had grade 3, 4 patients had grade 2, and 1 patient had grade 1 FI, preoperatively. Muscle atrophy and FI are irreversible phenomena and continue even after successful repair; however, they do not have a significant influence on the functional outcome at short-term follow-up after cuff repair. Repairing cuff with higher grades of FI can be performed as they achieve significantly improved functional outcomes.

Clinical and functional results of patients after arthroscopic single row rotator cuff repair and arthroscopic acromioplasty

Aim: The present study aims to evaluate clinical and functional results of arthroscopic single row rotator cuff repair and acromioplasty in patients with Rotator cuff tears (RCT). Materials and Methods: Sixty one patients whom were applied arthroscopic single row rotator cuff repair and arthroscopic acromioplasty between 2016 and 2019 were included in the present study. Patients’ rotator cuff tears (Patte classification) and acromion were classified based on X-ray and Magnetic Resonance Imaging (MRI) results. In addition, patients’ Constant Murley Scores, Shoulder Range of Motion (ROM) and visual analogue scale (VAS) scores were also analyzed prior to and following the surgical operation. Results: Forty one (67.2%) out of 61 patients in the present study were applied surgery on the right shoulders, while 20 of them (32.8%) were applied surgery on the left shoulders. Twenty one (34.4%) of patients were male, while 40 (65.6%) of them were female. Patients were divided into three groups as type 1 (n=10), type 2 (n=41), type 3 (n=10) based on their acromion classification and three stages as stage 1 (n= 15), stage 2 (n=36), and stage 3 (n=10) based on their rotator cuff tears. In addition, while their mean preoperative Constant-Murley and VAS scores were 29.8±0.79 and 9.14±0.11, respectively, it increased to 81.1±1.07 and decreased to 2.06±1.07 in the postoperative period, respectively. Finally, while patients’ preoperative mean abduction ROM was 60.73°±1.31°, it increased to 126.22°±2.27° in the postoperative period. Conclusion: Arthroscopic single row rotator cuff repair and arthroscopic acromioplasty in patients suffering from RCT contributes to significant relief of pain and remarkable increase in shoulder abduction ROM, thus offering an effective and reliable surgical treatment which allows the active use of extremities.

All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears

Background: All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. Purpose: To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). Results: On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). Conclusion: In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.

A Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears

To compare the clinical and imaging outcomes between the suture bridge technique (SB) and the medially based single-row technique (medSR) in patients with 1- to 3-cm tear sizes. All patients were evaluated preoperatively and postoperatively (at 12 and 24months) using the modified University of California, Los Angeles scoring system; active range of motion (flexion and external rotation); and a visual analog scale for pain. Healing status was examined by postoperative magnetic resonance imaging. Clinical and imaging evaluations were completed by 92 patients at 1-year follow-up and by 74 patients at 2years. No significant differences were found between the 2 groups across all measures at final follow-up: The University of California, Los Angeles scores were 33.4 points in SB patients and 33.0 points in medSR patients (P= .58); the visual analog scale scores were 6mm and 7mm, respectively (P= .38); the active flexion angles were 161° and 159°, respectively (P= .34); and the external rotation angles were 49° and 52°, respectively (P= .37). Retears were observed in 6.5% of SB patients and 2.1% of medSR patients (P= .31). Medial cuff failure was observed only in SB patients (4.3%, 2 cases), whereas incomplete healing (deep-layer retraction pattern) was observed only in medSR patients (8.7%, 4 cases). Neo-tendon regeneration in the medSR group was observed in 93% of patients. This study did not show any significant differences in the clinical outcomes and cuff integrity between the 2 treatment groups at final follow-up; however, medial cuff failure was observed only in the SB group, and incomplete healing was more frequent in the medSR group. One should consider the risk of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears. Level I, therapeutic, prospective, randomized trial.

Evaluation of clinical and functional outcomes of arthroscopic single row rotator cuff repair in our institution; a retrospective study

Introduction: Various recent clinical literature and industrial commercial interests has shifted the focus from SR rotator cuff repair towards DR repair. The Aim of our study was to evaluate the functional outcomes of patients with rotator cuff tear treated in our institute by Arthroscopic SR Rotator cuff repair. Materials and Methods: A total of 54 patients with full thickness rotator cuff tear treated with arthroscopic SR rotator cuff repair in our institute for a period from February 1, 2014 to October 31, 2016 were evaluated retrospectively after confirming the rotator cuff tear clinically and by MRI. Clinico-Functional assessment was done using UCLA score. Results: Mean UCLA Score was 18.69 ± 3.7 preoperatively to 32.07 ± 1.47 postoperatively after more than 2 years of follow up and showed significant improvement in UCLA Scores. Results were Graded as Excellent in 42 (78%), Good in 10(19%) and Poor in 2(3%) patients. On comparison of our results with other published studies, our results was statistically significant (P Conclusion : Results of Arthroscopic single row rotator Cuff repair in our Institute showed excellent results, is a cost effective technique with the Clinico-Functional results being Good to Excellent in majority of our cases as per UCLA score, comparable to any published series of SR RCR. Keywords: Shoulder Arthroscopy, RCT (Rotator cuff tear), SR (Single Row repair), DR (Double Row repair), UCLA score.

Footprint coverage comparison between knotted and knotless techniques in a single-row rotator cuff repair: biomechanical analysis

BackgroundThe objective of this biomechanical study is to compare two variations of single-row knotless techniques (Knotless repair and Rip-stop Knotless repair) against a single-row double-loaded anchor (DL) repair, focused on evaluating contact pressure and contact area amongst three different single-row techniques for rotator cuff repairs.MethodsA total of 24 fresh frozen human shoulders were tested. Specimens were randomly assigned into one of the three single-row (SR) repair groups: A Knotted single-row double-loaded anchor (DL) repair, a Knotless (K) repair, or a Knotless Rip-Stop (KRS) repair. The footprint was measured after complete detachment of the supraspinatus tendon from the greater tuberosity, introducing pressure sensors between bony footprint and detached rotator cuff, and finally reconstructing it. All specimens were mounted onto a servohydraulic test system to analyze contact variables at 0° and 30° of abduction with 0 N, 30 N and 50 N of tension.ResultsGroups did not differ significantly in their footprint sizes: DL group 359.75 ± 58.37 mm2, K group 386.5 ± 102.13 mm2, KRS group 415.87 ± 93.80 mm2 (p = 0.84); nor in bone mineral density: DL group 0.25 ± 0.14 g/cm2, K group 0.32 ± 0.19 g/cm2, KRS group 0.32 ± 0.13 g/cm2, (p = 0.75) or average age. The highest mean pressurized contact area measured for the K repair was 248.1 ± 50.9 mm2, which equals a reconstruction of 67.1 ± 19.3% at 0° abduction and a 50 N supraspinatus load. This reconstructed area was significantly greater compared with the DL repair 152.8 ± 73.1 mm2, reconstructing 42.0 ± 18.5% on average when under the same conditions (p = 0.04). The mean contact pressure did not significantly differ amongst groups (p = 1.0): DL group 30.8 ± 17.4 psi, K group 30.9 ± 17.4 psi and KRS group 30.0 ± 10.9 psi. Neither the 30° abduction angle nor the supraspinatus load had a significant influence on the contact pressure in our study.ConclusionBoth single-row knotless techniques resulted in significantly higher footprint reconstruction, providing larger contact area and a more uniform pressure distribution when compared with the single-row Knotted techniques. The mean contact pressure did not differ among groups significantly. These knotless techniques may be an alternative if the surgeon decides to perform a single-row rotator cuff repair.Level of evidenceBasic Science Study, Biomechanics.

Osteoconductive resorption characteristics of a novel biocomposite suture anchor material in rotator cuff repair

BackgroundBioabsorbable suture anchors have been associated with bone-derived complications, such as osteolysis and cyst formation, after rotator cuff repair. The purpose of this study was to assess the osseous degradation process of the novel biocomposite suture anchor material polylactic-co-glycolic acid (PLGA)/beta-tricalcium phosphate (ß-TCP)/calcium sulfate (CS) after arthroscopic single-row rotator cuff repair. The focus of interest was the appearance of osteolysis and the rate of total resorption of the implants after 21 months.MethodsForty-eight patients with 82 implanted suture anchors who had undergone arthroscopic rotator cuff repair between January 2015 and March 2016 at our institution were retrospectively evaluated by postoperative magnetic resonance imaging. The appearance of osteolysis was classified by measurement of the peri-implant fluid. The degree of resorption was measured by grading the persistent visibility of the anchor structures. The integrity of the rotator cuff tendon was analyzed to discover possible retear or anchor pull-out complications.ResultsAfter a follow-up of 21.2 (± 5.4) months, osteolysis was detected in only two anchors (2.4%), and none of these defects exceeded the diameter of the former suture anchor (5.5 mm). Fifty percent of the anchors were fully degraded and no longer visible. Furthermore, only two retears of the rotator cuff occurred, and no anchor pull-out complications were detected.ConclusionPGLA/β-TCP/CS is a fully resorbable and osteoconductive suture anchor material that seems to have superior resorption characteristics compared to those of other bioabsorbable suture anchor materials commonly used in arthroscopic rotator cuff repair.Trial registrationThe presented study was retrospectively registered by the commission for ethics at the Ärztekammer Nordrhein with the registration number 2016433 on January 17, 2017. All participating patients gave written consent for participation and the publication of their data.Level of evidenceIV

Triple-Loaded Suture Anchors Versus a Knotless Rip Stop Construct in a Single-Row Rotator Cuff Repair Model

To compare the biomechanical properties of single-row repair with triple-loaded (TL) anchor repair versus a knotless rip stop (KRS) repair in a rotator cuff repair model. Rotator cuff tears were created in 8 cadaveric matched-pair specimens and repaired with a TL anchor or KRS construct. In the TL construct, anchors were placed in the greater tuberosity and then all suture limbs were passed through the rotator cuff as simple sutures and tied. In the KRS construct, a 2-mm suture tape was passed through the tendon in an inverted mattress fashion, and a free suture was passed medial to the suture tape to create a rip-stop. Then, the suture tape and free suture were secured with knotless anchors. Displacement was observed with video tracking after cyclic loading, and specimens were loaded to failure. The mean load to failure was 438 ± 59N in TL anchor repairs compared with 457 ± 110N in KRS repairs (P=.582). The mean displacement with cyclic loading was 3.8 ± 1.6mm in TL anchor repairs versus 4.3 ± 1.8mm in the KRS group (P= .297). Mode of failure was consistent in both groups, with 6 of 8 failures in the TL anchor group and 7 of 8 failures in KRS group occurring from anchor pullout. There is no statistical difference in load to failure and cyclic loading between TL anchor and KRS single-row repair techniques. KRS repair technique may be an alternative method of repairing full-thickness supraspinatus tendon tears with a single-row construct.

Single-row Rotator Cuff Repair: SpeedFix and Triple-loaded Anchor

Single-row Rotator Cuff Repair: SpeedFix and Triple-loaded Anchor

The Effect of Hand Dominance on Functional Outcome Following Single Row Rotator Cuff Repair

Introduction:Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be obtained with surgical treatment although this outcome is affected by several factors. We sought to investigate the effect of hand dominance on subjective functional outcome post rotator cuff repair.Methods:All patients who had rotator cuff repair over a calendar year were identified and followed up at 3 years post operatively. Patients were consented for inclusion in the study and demographic data, hand dominance and functional outcome data was collected. L’insalata shoulder questionnaire was used for outcome data collection. SPSS version 22 was used for statistical analysis where appropriate.Results:144 patients were included in this study. Mean age was 63 +/- 10.1 years in the dominant side group and 62 +/- 8.6 years in the non-dominant group. 92 patients had dominant side surgery and 52 had non-dominant side surgery. There was a statistically significant correlation between dominant hand and operated side (P=0.005). The mean overall outcome score was marginally higher in the dominant surgery group with a mean of 89.8 +/- 14.2 compared with a mean of 87.4 +/- 17.5 in the non-dominant group. Multi-variate linear regression analysis revealed this difference to be non-significant (p = 0.4).Conclusion:No difference was found in the functional outcome of rotator cuff repair between dominant and non-dominant side surgery. This information will help in counselling patients who are concerned about the potential impact of rotator cuff repair on the function of their dominant hand.

Biomechanical Comparison of Standard and Linked Single-Row Rotator Cuff Repairs in a Human Cadaver Model

The purpose of this study was to evaluate the time zero cyclic and failure loading properties of a linked single-row rotator cuff repair compared with a standard simple suture single-row repair using triple-loaded suture anchors. Eighteen human cadaveric shoulders from 9 matched pairs were dissected, and full-thickness supraspinatus tears were created. The tendon cross-sectional area was recorded. In each pair, one side was repaired with a linked single-row construct and the other with a simple suture single-row construct, both using 2 triple-loaded suture anchors. After preloading, specimens were cycled to 1MPa of effective stress at 1Hz for 500 cycles, and gap formation was recorded with a digital video system. Samples were then loaded to failure, and modes of failure were recorded. There was no statistical difference in peak gap formation between the control and linked constructs (3.6 ± 0.9mm and 3.6 ± 1.2mm, respectively; P= .697). Both constructs averaged below a 5-mm cyclic failure threshold. There was no statistical difference in ultimate load to failure between the control and linked repair (511.1 ± 139.0N and 561.2 ± 131.8N, respectively; P=.164), and both groups reached failure at loads similar to previous studies. Constructs failed predominantly via tissue tearing parallel to the medial suture line. The linked repair performed similarly to the simple single-row repair. Both constructs demonstrated high ultimate load to failure and good resistance to gap formation with cyclic loading, validating the time zero strength of both constructs in a human cadaveric model. The linked repair provided equivalent resistance to gap formation and failure loads compared with simple suture single-row repairs with triple-loaded suture anchors. This suggests that the linked repair is a simplified rip-stop configuration using the existing suture that may perform similarly to current rotator cuff repair techniques.