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Bae GC, Kwon WH, Na Y, Hwang YJ, Ryu DJ, D’Lima DD, Jeon YS. Clinical Outcomes and Repair Integrity After Double-Row Modified Mason-Allen Repair Technique With a Single Knot in Small to Medium Supraspinatus Tears. Orthop J Sports Med 2024; 12:23259671241246768. [PMID: 38665386 PMCID: PMC11044770 DOI: 10.1177/23259671241246768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/05/2023] [Indexed: 04/28/2024] Open
Abstract
Background Various arthroscopic rotator cuff repair techniques are being used for the treatment of rotator cuff tears with the development of surgical instruments. However, retears after repair are not completely avoidable, and efforts to reduce retears remain a challenge. Purpose/Hypothesis To introduce a new repair technique, the double-row modified Mason-Allen technique with a single knot, and to compare clinical outcomes and retear rates with the single-row modified Mason-Allen technique. It was hypothesized that this new technique would have a better clinical outcome and significantly lower retear rate than the single-row modified Mason-Allen technique. Study Design Cohort study; Level of evidence, 3. Methods A total of 110 patients with small- to medium-sized (<1.5 cm) full-thickness supraspinatus tears were enrolled into 2 groups, with 65 patients receiving the single-row modified Mason-Allen technique (group A) and 45 patients receiving the double-row modified Mason-Allen technique with a single knot (group B). The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analog scale (VAS) for pain and satisfaction scores. All patients enrolled in this study were monitored for a minimum of 24 months. Magnetic resonance imaging was performed to analyze the integrity of tendons and retear at 6 months after surgery. Results No statistically significant differences between the 2 groups were found regarding the VAS for pain, ASES, and DASH scores. However, retear was found in 9 patients (13.8%) in group A and 1 patient (2.2%) in group B. The difference in the retear rate was statistically significant between the 2 groups (P = .037). Conclusion A significantly lower retear rate and comparable clinical outcomes were seen after the double-row modified Mason-Allen repair technique with a single knot when compared with the single-row modified Mason-Allen technique. Based on these findings, the double-row modified Mason-Allen repair technique with a single knot can be considered a surgical treatment option that can provide sufficient stability in small- to medium-sized supraspinatus tears.
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Affiliation(s)
- Gi Cheol Bae
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Won Hwan Kwon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yoon Joong Hwang
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Yoon Sang Jeon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
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Itoigawa Y, Uehara H, Tsurukami H, Koga A, Morikawa D, Maruyama Y, Ishijima M. The Combined Suture Bridge With Mason-Allen Technique Is Superior to the Conventional Suture Bridge Technique for Arthroscopic Rotator Cuff Repair. Arthroscopy 2024; 40:674-680. [PMID: 37495088 DOI: 10.1016/j.arthro.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To compare clinical results and retear rates between the combined suture bridge with Mason-Allen (SBMA) technique and the conventional suture bridge (SB) technique in patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair. METHODS One hundred two patients who underwent arthroscopic rotator cuff repair using the SB technique (n = 50) or SBMA technique (n = 52) for a full-thickness rotator cuff tear and had at least 2 years of follow-up were retrospectively analyzed. Magnetic resonance imaging was performed before surgery and 2 years after to determine preoperative tear size, Goutallier stage, and presence of retear after surgery. Patients were clinically evaluated using the Japanese Orthopaedic Association (JOA) score. RESULTS The groups did not significantly differ in terms of follow-up period, age, sex, tear size, Goutallier stage, or number of suture anchors. The retear rate was significantly lower in the SBMA group (7.7% vs 28.0%; P < .01). The JOA score was significantly higher at last follow-up than before surgery in both groups (P <.01). The JOA score at last follow-up was significantly higher in the SBMA group (P = .02). CONCLUSIONS Arthroscopic rotator cuff repair using the SBMA technique may provide better clinical and anatomical outcomes than the conventional SB technique. LEVEL OF EVIDENCE Level III, retrospective cohort design; treatment study).
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hironori Tsurukami
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Figueiredo JA, Sarmento M, Moura N, Gomes DS, Cartucho A. Knotted or knotless double-row rotator cuff repair retear rates: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:15-19. [PMID: 38323203 PMCID: PMC10840561 DOI: 10.1016/j.xrrt.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Arthroscopic rotator cuff tear repair techniques used to rely on knot-tying double row techniques, but the advent of knotless transosseous equivalent procedures introduced a new variable to the debate. The purpose of this study is to determine which technique is associated with lower retear rates. For its' biomechanical advantages, the authors' hypothesis is that knotless techniques would have lower retear rates. Methods A systematic literature search was performed via PubMed and Google Scholar by two independent reviewers following PRISMA guidelines. Papers reporting retear rates after rotator cuff arthroscopic repair using knotted double-row or knotless transosseous equivalent techniques, evaluated by magnetic resonance imaging at least 6 months after surgery, were retrieved. Studies that do not differentiate between techniques and nonclinical reports were excluded. Eligible data was analyzed with Review Manager 5.4.1 using Mantel-Haenszel statistics with a fixed effect model. Results The authors' initial literature search retrieved 511 reports. After the selection process, 24 articles were available for this review, and 9 were eligible for meta-analysis. A comparison of 1888 subjects from noncomparative reports and a meta-analysis of reports in which both techniques were studied could not show a statistically significant difference in technique retear rates. Discussion and conclusion The current report revealed no significant difference in retear rates between the two arthroscopic repair techniques. Studies' quality was a limitation. Only two reported level 1 evidence. This review could not control variables such as cuff tear size, tissue quality, or individual comorbidities. Larger and longer follow-up studies could be helpful to further investigate this topic.
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Affiliation(s)
- João A. Figueiredo
- Department of Orthopaedic and Trauma Surgery, Hospital de Cascais, Cascais, Portugal
| | - Marco Sarmento
- Department of Shoulder and Elbow Surgery, Hospital CUF Descobertas, Lisbon, Portugal
| | - Nuno Moura
- Department of Shoulder and Elbow Surgery, Hospital CUF Descobertas, Lisbon, Portugal
| | - Diogo Silva Gomes
- Department of Shoulder and Elbow Surgery, Hospital CUF Descobertas, Lisbon, Portugal
| | - António Cartucho
- Department of Shoulder and Elbow Surgery, Hospital CUF Descobertas, Lisbon, Portugal
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Seok HG, Park SG. Radiologic and clinical outcomes of an arthroscopic bridging graft for irreparable rotator cuff tears with a modified MasonAllen stitch using a plantaris tendon autograft: a case series with minimum 2-year outcomes. Clin Shoulder Elb 2023; 26:406-415. [PMID: 37559524 DOI: 10.5397/cise.2022.01445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Surgical management of a massive rotator cuff tear (RCT) is always challenging. This study describes the clinical and radiological outcomes of patients who underwent bridging grafts using a plantaris tendon for an irreparable RCT. METHODS Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon. RESULTS A statistically significant improvement at the final follow-up was evident in scores for the VAS (-3.0, P=0.003), ASES (24.9, P=0.002), D ASH (-20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported. CONCLUSIONS An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients. Level of evidence: IV.
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Affiliation(s)
- Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Johnson AH, West M, Fowler MB, Petre BM, Turcotte JJ, Redziniak DE. What is the Optimal Construct to Reduce Failure in Arthroscopic Four Anchor Rotator Cuff Repair? Shoulder Elbow 2023; 15:33-39. [PMID: 37974601 PMCID: PMC10649482 DOI: 10.1177/17585732221076066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2023]
Abstract
Background Re-tear following rotator cuff repair (RCR) is a concerning complication that can lead to poor patient outcomes and necessitate the need for revision surgery. The purpose of our study was to look at the combined construct of knotted vs. knotless medial row and suture vs. suture tape, focusing primarily on re-tear rates following surgery. Methods A retrospective observational study of 343 consecutive patients undergoing arthroscopic double row, 4-anchor rotator cuff repair from February 2014 to March 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities and tear characteristics between patients who experienced a symptomatic re-tear and those who did not. Results The overall symptomatic re-tear rate was 7.6%. Patients who had a knotted medial row repair had a significantly lower rate of re-tear (4.7 vs. 11.3%, p = 0.022). Patients that had a knotted medial row and suture tape repair were significantly less likely to experience a re-tear (OR: 0.180, p = 0.001). Discussion The use of suture tape and a knotted medial row repair decreases the incidence of symptomatic re-tear following rotator cuff repair. The combined construct of suture tape and a knotted medial row in rotator cuff repair decreases the risk for symptomatic re-tear following surgery.
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Affiliation(s)
- Andrea H Johnson
- Research Fellow, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Michaline West
- Clinical Research Coordinator, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - M Brook Fowler
- Clinical Research Coordinator, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Benjamin M Petre
- Attending Orthopedic Surgeon, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Justin J Turcotte
- Director, Orthopedic and Surgical Research, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Daniel E Redziniak
- Attending Orthopedic Surgeon, Anne Arundel Medical Center Orthopedics, Annapolis, MD
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Takahashi R, Kajita Y, Harada Y, Iwahori Y. Preemptive middle glenohumeral ligament release in arthroscopic rotator cuff repair does not reduce the postoperative stiffness: a retrospective comparative study. BMC Musculoskelet Disord 2023; 24:490. [PMID: 37322461 DOI: 10.1186/s12891-023-06611-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of preemptive middle glenohumeral ligament (MGHL) release in arthroscopic rotator cuff repair (ARCR) to reduce postoperative stiffness. METHODS Patients who underwent ARCR were enrolled and allocated into two groups retrospectively: the preemptive MGHL release group (n = 44) and the preemptive MGHL non-release group (n = 42). Clinical outcomes were assessed and compared between the two groups, including the range of motion, Japanese Orthopedic Association Shoulder Score, Constant Shoulder Score, and the University of California, Los Angeles Score preoperatively and 3 months, 6 months, and 12 months postoperatively and complications. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging. RESULTS There were no significant differences between the groups in all range of motion and all functional scores at any of the assessed time points. There was also no significant difference in the healing failure rate 2.3% in the preemptive MGHL group and 2.4% in the preemptive MGHL non-release group (p = .97), and postoperative stiffness was 2.3% in the preemptive MGHL group and 7.1% in the preemptive MGHL non-release group (p = .28). There was no postoperative instability in both group. CONCLUSION ARCR effectively facilitates the recovery of range of motion and function in patients with a rotator cuff tear. However, preemptive MGHL release could not be an effective method to reduce postoperative stiffness.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1Jihira, Ichinomiya City, 494-0001, Kaimei, Aichi, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1Jihira, Ichinomiya City, 494-0001, Kaimei, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Hiroshima, Japan
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, 2090 Shimoharacho Azamurahigashi, Kasugai, 486-0819, Aichi, Japan
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Huang Q, Li X, Zhang Y, Jian C, Mou H, Ou Y. Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis. BMC Surg 2023; 23:158. [PMID: 37312138 DOI: 10.1186/s12893-023-02060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE This investigation aimed to compare the medical efficacy of the knotted and knotless suture-bridge procedures in rotator cuff repair. METHODS The Pubmed, Embase, and Cochrane Library datasets were searched for all available publications comparing the medical results of arthroscopic rotator cuff repairs utilizing knotted or knotless suture-bridge procedures. Two researchers utilized Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to evaluate the included studies. Employing Revman 5.3 software, meta-analysis was conducted following the PRISMA reporting guideline. RESULTS Eleven investigations with 1083 patients were considered suitable for the final meta-analysis. 522 individuals were assigned to the knotted group, whereas 561 were assigned to the knotless group. No statistical difference was found between the knotted and knotless groups, regarding VAS score (WMD, 0.17; 95% CI, - 0.10 to 0.44; P = 0.21); Constant score (WMD, -1.50; 95% CI, - 3.52 to 0.52; P = 0.14); American Shoulder and Elbow Surgeons Shoulder (WMD, -2.02; 95% CI, - 4.53 to 0.49; P = 0.11); University of California Los Angeles score (WMD, -0.13; 95% CI, - 0.89 to 0.63; P = 0.73); ROM of flexion (WMD, 1.57; 95% CI, - 2.11 to 5.60; P = 0.37), abduction (WMD, 1.08; 95% CI, - 4.53 to 6.70; P = 0.71) and external rotation (WMD, 1.90; 95% CI, - 1.36 to 5.16; P = 0.25); re-tear rate (OR, 0.74; 95% CI, 0.50 to 1.08; P = 0.12), and medical complications (OR, 0.90; 95% CI, 0.37 to 2.20; P = 0.82). CONCLUSION For arthroscopic rotator cuff repairs, there were no statistical differences in medical results among knotted and knotless suture-bridge procedures. Overall, both techniques showed excellent clinical outcomes and could be safely utilized to treat rotator cuff injuries.
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Affiliation(s)
- Qiu Huang
- Department of Orthopedics, People's Hospital of Leshan, Shizhong District, Leshan, Sichuan, China
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyu Li
- Department of Orthopedics, People's Hospital of Leshan, Shizhong District, Leshan, Sichuan, China
- Humanities and Management college, Southwest Medical University, Longmatan District, Luzhou, Sichuan, China
| | - Ye Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changchun Jian
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Mou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Xiao Q, Quan X, Hu S, Xiao Y, Wu J, Nie M. A comparison between knotted and knotless medial row of suture bridge technique in arthroscopic rotator cuff repair surgery: a meta-analysis. J Orthop Surg Res 2023; 18:338. [PMID: 37158896 PMCID: PMC10169486 DOI: 10.1186/s13018-023-03812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The shoulder arthroscopic suture bridge technique is currently very popular, but scientific evidence relating to the clinical outcomes of the medial row with or without knots has not been systematic reviewed. PURPOSE The purpose of this study was to compare the clinical outcomes of knotted versus knotless double-row suture bridges for rotator cuff repairs. STUDY DESIGN Meta-analysis. METHOD Five databases that contain literature in English were searched (Medline, PubMed, Embase, Web of Science, and the Cochrane Library), with a focus on works published between 2011 and 2022. Clinical data relating to arthroscopic rotator cuff repair with the suture bridge approach was examined and the outcomes of medial row knotting contrasted with that of the knotless technique. The search phrase used was: (double row) AND (rotator cuff) AND (repair), and the search method is subject term plus free word search. Literature quality evaluation was performed using the Cochrane "risk of bias" tool 1.0 and the Newcastle-Ottawa scale quality assessment instrument. RESULTS One randomized controlled trial, four prospective cohort studies, and five retrospective cohort studies were included in this meta-analysis. Data pertaining to 1146 patients was drawn from these ten original papers and analyzed. Meta-analyses that were performed on 11 postoperative outcomes revealed that none of the differences were statistically significant (P > 0.05) and that the publications were unbiased (P > 0.05). Postoperative retear rate and postoperative retear categorization were the outcomes assessed. Scores on postoperative pain, forward flexion, abduction, and external rotation mobility were collated and evaluated. The University of California, Los Angeles scoring systems in the first year following surgery, the American Shoulder and Elbow Surgeons score and Constant scales in the first and second years after surgery were the secondary outcomes spotlighted in this study. CONCLUSION The clinical outcomes of shoulder arthroscopic rotator cuff repair with the suture bridge technique with or without a knotted medial row was proven to be equivalent. These outcomes are about postoperative retear, postoperative retear classification, postoperative shoulder function score, postoperative shoulder mobility, and postoperative pain, respectively. It should be noted that the conclusions are based on short-term clinical follow-up data.
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Affiliation(s)
- Qiuping Xiao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Nanchuan District People's Hospital, Chongqing, China
| | - Xiaolin Quan
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shidong Hu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yujia Xiao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangping Wu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Mao Nie
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Turcotte JJ, Kelly M, West M, Lashgari C, Petre BM, Redziniak DE. Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair. J Clin Orthop Trauma 2023; 36:102083. [PMID: 36506592 PMCID: PMC9731871 DOI: 10.1016/j.jcot.2022.102083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
A common postoperative complication after rotator cuff repair is re-tear requiring a secondary procedure. Double row and trans-osseous equivalent repair techniques have become increasingly popular in recent years, however repair failure remains a relatively common complication after primary rotator cuff repair. A retrospective observational study of 389 consecutive patients undergoing arthroscopic double-row rotator cuff repair from February 1, 2014 to March 31, 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities, and tear characteristics between patients who experienced re-tear and those who did not. Repair failures were confirmed by plain MRI or intraoperatively during repeat surgical treatment. A subgroup analysis of patients who experienced re-tear due to medial row failure was conducted. The overall re-tear rate was 8.2% (32 patients). Six patients (1.5%) experienced medial row failure, while 26 patients (6.7%) experienced lateral row failure. The average time to re-tear was 279.3 ± 291.2 days. On multivariate analysis, patients with Goutallier Classification ≥3 (OR: 4.274, p = 0.046) and 3 anchor repair (OR: 5.387, p = 0.027) were at significantly increased risk for any re-tear after controlling for other tear characteristics. No statistically significant independent risk factors for medial row failure were identified after controlling for confounding variables. Goutallier classification greater than 3 and a primary repair with 3 anchors are significant risk factors for re-tear after double row rotator cuff repair, however they are not associated with increased occurrence of medial row failure. Further evaluation of risk factors for medial row failure is required to avoid this rare but serious re-tear pattern.
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Bowen E, Allen A, Bedi A. Rotator Cuff Repair: How Many Rows? OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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11
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Mancini MR, Horinek JL, Phillips CJ, Denard PJ. Arthroscopic Rotator Cuff Repair. Clin Sports Med 2023; 42:81-94. [DOI: 10.1016/j.csm.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Srimongkolpitak S, Chernchujit B. 3-in-1 Hybrid Suture Bridge Technique in Posterosuperior Rotator Cuff Tear. Arthrosc Tech 2022; 11:e1453-e1461. [PMID: 36061469 PMCID: PMC9437531 DOI: 10.1016/j.eats.2022.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023] Open
Abstract
Our technique repaired the posterosuperior rotator cuff tear in the full-thickness type. The key successful of the arthroscopic full-thickness rotator cuff repair has several suture techniques. First, it will distribute a tensile force throughout the entire tendon. Second, it will improve tendon healing by getting it closer to the medial anatomical footprint. Third, the suture bridge compression technique has been used to compress all layers of the repaired tendon against the bone with the total contact area. Fourth, it reduces the risk of cut through the rotator cuff and the rate of rotator cuff retear with a tension free repair. We used three suture limbs in one hole to reduce rotator cuff damage and the rate of retear and also only tie three medial row knots. The reasons are to compress anatomically the medial footprint. The configuration suture pattern consists of suture bridges that distribute pressure-tension over a larger contact surface area on the tendon-bone interface, allowing for robust tendon-bone stabilization, better tendon-bone healing, and less retear after repair.
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Affiliation(s)
- Surasak Srimongkolpitak
- Department of Orthopedics, Faculty of Medicine, Queen Savang Vadhana Memorial Hospital, Si Racha District, Chon Buri Province, Thailand
| | - Bancha Chernchujit
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand,Address correspondence to Dr. Bancha Chernchujit, M.D., Department of Orthopedics, Faculty of Medicine, Thammasat University, Phaholyothin Frontage Rd, Khlong Nueng, Klongluang District, Pathum Thani 12120, Thailand.
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Guo J, Long Y, Zhou M, He ZH, Zeng WK, Yu ML, Yamuhanmode A, Tang YY, Li FQ, Meng K, Hou JY, Yang R. H-loop Knotless Double-Row Repair Versus Knotted Suture Bridge for Rotator Cuff Tears: A Biomechanical and Histological Study in an Animal Model [Formula: see text]. Am J Sports Med 2022; 50:1948-1959. [PMID: 35536125 DOI: 10.1177/03635465221090605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knotted suture bridge repair (KSBR) has been widely proven to be an effective method for rotator cuff repairs. However, the occurrence of type 2 failure after suture bridge repair remains a frequent problem because of the stress concentration and disturbance of tendon perfusion in the medial row. The authors have developed the H-loop knotless double-row repair (HLDR) to counteract these problems. PURPOSE To compare the biomechanical and histological outcomes of HLDR and KSBR for rotator cuff tear in the rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Acute bilateral supraspinatus tears were created on the shoulders of 46 New Zealand White rabbits. HLDR and KSBR were randomly performed on the left side or right side. Thirteen animals each were sacrificed at 2, 4, and 8 weeks after surgery (n = 39), with 6 rabbits used for histological evaluation and the other 7 rabbits for biomechanical testing. The remaining 7 animals from the original 46 were only used for initial biomechanical evaluation at week 0. RESULTS Macroscopically, all repaired tendons were connected to their footprint on the greater tuberosity without postoperative complications at 8 weeks after surgery. The HLDR group had significantly better histological bone-to-tendon integration compared with the KSBR group in terms of fibrocartilage regeneration, collagen composition, and fiber organization. The biomechanical outcomes in the HLDR group were demonstrated to be better than those of the KSBR group at time 0 and 8 weeks after surgery. CONCLUSION Both repair techniques were effective for rotator cuff tears in a rabbit rotator cuff tear model; however, HLDR demonstrated more advantages in improving biomechanical properties and histological tendon-to-bone healing compared with KSBR. CLINICAL RELEVANCE This animal study suggested that HLDR might be an alternative choice for rotator cuff tears in humans to increase tendon-to-bone healing and reduce the rate of failure to heal.
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Affiliation(s)
- Jiang Guo
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China.,Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yi Long
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Min Zhou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Zhang-Hai He
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Wei-Ke Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Meng-Lei Yu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Alike Yamuhanmode
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Yi-Yong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Fang-Qi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Ke Meng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Jing-Yi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
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Zhi X, Zhang Y, Li W, Wang Y, Zou Y, Lu L, Kong C, Xu D, Zhu Y, Wei S. Absorbable suture anchor and knotless anchor techniques produced similar outcomes in arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:2158-2165. [PMID: 35099599 DOI: 10.1007/s00167-021-06855-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to compare absorbable suture anchor with knotless anchor techniques for arthroscopic anterior talofibular ligament (ATFL) repair. METHOD A multicenter retrospective study was performed with 185 patients, who had undergone an arthroscopic ATFL repair procedure using absorbable suture anchor or knotless anchor between May 2017 and October 2019. The follow-up time was a minimum of 18 months. Karlsson-Peterson score, visual analogue scale (VAS), and Cumberland ankle instability tool (CAIT) were evaluated. The complications were also recorded. RESULTS One hundred and seven patients underwent one absorbable suture anchor repair procedure (Group A [A]), and the other seventy-eight patients underwent one knotless anchor repair procedure (Group B [B]). At the final follow-up, both Karlsson-Peterson score (A, pre 61.0 ± 8.0 vs post 93.5 ± 5.3, P < 0.001; B, pre 59.5 ± 8.2 vs post 92.4 ± 6.3, P < 0.001), VAS score (A, pre 5.0 ± 1.3 vs post 0.5 ± 0.7, P < 0.001; B, pre 5.5 ± 1.2 vs post 0.9 ± 1.0, P < 0.001), and CAIT score (A, pre 53.1 ± 12.0 vs post 93.1 ± 6.6, P < 0.001; B, pre 51.6 ± 12.0 vs post 93.1 ± 6.5, P < 0.001) improved significantly in both groups. There was no significant difference between the two groups regarding the Karlsson-Peterson score (A, pre 61.0 ± 8.0 vs B, pre 59.5 ± 8.2, n.s; A, post 93.5 ± 5.3 vs B, post 92.4 ± 6.3, n.s), CAIT score (A, pre 53.1 ± 12.0 vs B, pre 51.6 ± 12.0, n.s; A, post 93.1 ± 6.6 vs B, post 93.1 ± 6.5, n.s) and the change ranges of VAS (A, 4.5 ± 1.0 vs B, 4.6 ± 1.2, n.s). Anchor complications were easier to occur in Group B (0/107 vs 6/78, P = 0.007). Knot irritation slightly increased in Group A (10/107 vs 0/78, P = 0.006). No significant difference was found regarding total complication rates (A, 10/107 vs B, 6/78, n.s). CONCLUSION Absorbable suture anchor and knotless anchor for arthroscopic ATFL repair produced similar clinical outcomes. The ankle stability scores increased significantly in both groups. However, the knotless anchor has a higher risk to loosen, deviated direction or break, while the absorbable suture anchor still has a slim chance of knot irritation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xiaosong Zhi
- Foot and Ankle Sports Medicine Center, Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Yu Zhang
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopedics Hospital, Sichuan Province, Chengdu, China
| | - Weilin Li
- Department of Foot and Ankle, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Yong Wang
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopedics Hospital, Sichuan Province, Chengdu, China
| | - Yunxuan Zou
- Department of Foot and Ankle, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Lisha Lu
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopedics Hospital, Sichuan Province, Chengdu, China
| | - Changwang Kong
- Foot and Ankle Sports Medicine Center, Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Dan Xu
- Foot and Ankle Sports Medicine Center, Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Yongzhan Zhu
- Department of Foot and Ankle, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China.
| | - Shijun Wei
- Foot and Ankle Sports Medicine Center, Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China. .,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
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15
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Park SG, Seok HG. Use of an Arthroscopic Bridging Graft for Irreparable Rotator Cuff Tears With the Modified Mason-Allen Stitch Using a Tendon Autograft. Arthrosc Tech 2022; 11:e857-e861. [PMID: 35646557 PMCID: PMC9134310 DOI: 10.1016/j.eats.2021.12.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/27/2021] [Indexed: 02/03/2023] Open
Abstract
We describe a technique for treating irreparable rotator cuff tears (RCTs) by bridging grafts with a long tendon autograft. In this technique, the plantaris tendon is harvested and prepared in a Y-shaped graft. The folded end of the graft is anchored to the greater tubercle and the other 2 limbs are fixed to rotator cuff tissue using modified Mason-Allen stitches. The autograft can decrease the tension on the repair of irreparable RCTs and has biological superiority. Our clinical experience indicates this technique will bring superior integrity to irreparable RCT repairs.
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Affiliation(s)
- Sam-Guk Park
- Address correspondence to Sam-Guk Park, M.D., Ph.D., Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea.
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Zwolak P, Meyer P, Molnar L, Kröber M. The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors. Arch Orthop Trauma Surg 2022; 142:25-31. [PMID: 32844306 DOI: 10.1007/s00402-020-03584-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
To date two main techniques are used in arthroscopic full-thickness rotator cuff tears, the conventional knot-tying suture bridge technique and the knotless technique. We evaluated whether there is a difference in clinical outcome using both techniques. Our patients underwent arthroscopic treatment of full-thickness rotator cuff tears, and we retrospectively evaluated clinical function, strength and surgery time. Eighty-three shoulders operated between September 2012 and December 2013 were included in the study. We had nineteen patients in the knotless group, and sixty-four in the knot-tying group. In addition, we performed preoperatively radiological (magnetic resonance imaging-MRI) conformation of full-thickness rotator cuff tear in our patients. For clinical evaluation, we used Quick Disabilities of the Arm, Shoulder and Hand score (q-DASH) and the Shoulder Pain and Disability (SPADI) score, and we measured the strength of a range of motion postoperatively using a conventional dynamometer. The patients were evaluated preoperatively, and at 6, 9, and 12 months postoperatively. The follow-up period was 12 months. The scores in both treatment groups improved at twelve months follow-up, but there was no statistical difference between both groups at twelve months after surgery; q-DASH score between groups (p = 0.092) and SPADI score (p = 0.700). Similarly, there was no statistical difference between the groups in regard to strength, surgery time, and range of motion at the twelve months follow-up. Our data confirm that both techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome.Level of evidence IV.
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Affiliation(s)
- Pawel Zwolak
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland. .,Department of Orthopaedics and Trauma Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Philipp Meyer
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland
| | - Laszlo Molnar
- Orthopädische Klinik Luzern AG, Lucerne, Switzerland
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Buyukdogan K, Aslan L, Koyuncu Ö, Eren İ, Birsel O, Fox MA, Demirhan M. Long-term outcomes after arthroscopic transosseous-equivalent repair: clinical and magnetic resonance imaging results of rotator cuff tears at a minimum follow-up of 10 years. J Shoulder Elbow Surg 2021; 30:2767-2777. [PMID: 33991652 DOI: 10.1016/j.jse.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair. METHODS This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects. RESULTS A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 ± 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range, 10-12 years). The mean anteroposterior tear size was 3.1 ± 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P = .012), and tear retraction (OR, 4.07; 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis. CONCLUSION Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes.
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Affiliation(s)
- Kadir Buyukdogan
- Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Lercan Aslan
- Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Özgür Koyuncu
- Department of Orthopedics and Traumatology, Vehbi Koc Vakfı American Hospital, Istanbul, Turkey
| | - İlker Eren
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Michael A Fox
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mehmet Demirhan
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey.
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Yen JZ, Chuang HC, Hong CK, Hsu KL, Kuan FC, Chen Y, Su WR. The number of loaded sutures alter the suture-holding strength in different knotless suture anchors: a biomechanical study. JSES Int 2021. [DOI: 10.1016/j.jseint.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Triple-Row Technique Confers a Lower Retear Rate Than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs. Arthroscopy 2021; 37:3053-3061. [PMID: 33957211 DOI: 10.1016/j.arthro.2021.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the structural and clinical results between the knotless suture bridge (SB) and triple-row (TR) techniques. METHODS This study is a retrospective study and included 212 shoulders with repairable rotator cuff tears treated with the SB technique and 206 shoulders treated with the TR technique. In the TR technique, medial and lateral anchors were placed as they would be for the SB technique, with a middle row anchor added on the edge of footprint to reduce the torn tendons. All patients underwent primary arthroscopic rotator cuff repair and had magnetic resonance imaging 6 months postoperatively to evaluate for retear. Sugaya's classification was used to classify the retear pattern. The function of all patients preoperatively and 2 years postoperatively were assessed by the American Shoulder and Elbow Surgeons shoulder index and the University of California at Los Angeles rating scale. RESULTS According to Sugaya's classification, 24 (11.3%), 6 (2.8%), and 20 (9.4%) in SB-treated shoulders and 16 (7.8%), 12 (5.8%), and 8 (3.9%) in TR-treated shoulders, respectively had types 3, 4, and 5. There was a statistically significant greater type 5 retear in SB-treated shoulders (P = .038) than in TR-treated shoulders. The average clinical outcome scores at the final follow-up improved significantly relative to those before the surgeries in both groups. There were no statistical differences in the clinical outcome scores at the final follow-up between SB and TR groups. CONCLUSIONS The use of the TR technique in arthroscopic rotator cuff repair resulted in a lower large-size retear rate when compared with the use of the SB technique. No clinical differences were noted in the outcomes between the 2 groups. LEVEL OF EVIDENCE Level III, therapeutic, retrospective cohort study.
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20
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Longo UG, Carnevale A, Piergentili I, Berton A, Candela V, Schena E, Denaro V. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:749. [PMID: 34465332 PMCID: PMC8408924 DOI: 10.1186/s12891-021-04634-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04634-6.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.,Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
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21
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Fixationssysteme und Techniken zur arthroskopischen Rotatorenmanschettenrekonstruktion. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungArthroskopische Rotatorenmanschettenrekonstruktionen wurden initial mit einer einreihigen („single row“) Technik beschrieben. Im Rahmen technischer Weiterentwicklungen der arthroskopischen Chirurgie wurden diverse Techniken zur zweireihigen („double row“), transossären und transossär-äquivalenten Sehnenfixation entwickelt, nicht zuletzt durch eine zunehmende Verbreitung knotenloser Anker. Die klinischen Ergebnisse zeigen keine relevanten Unterschiede zwischen den jeweiligen Techniken. Biomechanisch sind zweireihige Rekonstruktionen jedoch durch Vergrößerung der Kontaktfläche an der Insertionsstelle und der erreichten Stabilität überlegen, insbesondere mit medial geknoteten Fäden, welche in eine laterale Reihe als sog. Suture-Bridge abgespannt werden. Klassischerweise wurden Schraubanker aus Metall für eine arthroskopische Sehnenfixierung verwendet. Im Laufe der letzten Jahre wurde das Anker-Portfolio jedoch durch moderne bioresorbierbare und nichtresorbierbare (PEEK) Schraub- und Einschlaganker sowie auch um reine Fadenanker (All-suture) erweitert. Ein allgemeingültiger Goldstandard für die Ankerverwendung existiert bis dato nicht, wobei die meisten gängigen Anker – zumindest bei guter Knochenqualität – ausreichende Stabilität gewährleisten. Beim Nahtmaterial kam es ebenso zu relevanten Weiterentwicklungen, sodass dem Versagen der Nähte heutzutage weniger Bedeutung zukommt. Das Aufkommen von bandartigem Nahtmaterial (Tapes) konnte in diversen biomechanischen Studien seine Überlegenheit nachweisen, jedoch ist bei geknoteten Techniken mit Tapes aufgrund des womöglich negativen Einflusses durch größere Knoten Vorsicht geboten. Nicht zuletzt ist die mediale Stichposition möglichst nahe des Rotatorenkabels von großer Bedeutung, da der häufigste Versagensmechanismus einer Rotatorenmanschettenrekonstruktion mit modernem Naht- und Ankermaterial weiterhin ein Hindurchschneiden der Fäden durch das vorgeschädigte Sehnengewebe ist.
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Ito K, Sakaguchi K, Sekihata H, Sugita N, Kadono Y. Biomechanical Properties of Double-Row Transosseous Rotator Cuff Repair Combined With the Cinch Stitch in the Lateral Row. Orthop J Sports Med 2021; 9:23259671211006040. [PMID: 34104659 PMCID: PMC8150424 DOI: 10.1177/23259671211006040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The self-cinching stitch has been verified to have high mechanical strength. The mechanical strength of combining transosseous rotator cuff repair (RCR) and the self-cinching stitch in the lateral row is unknown. Purpose/Hypothesis: The purpose of this study was to evaluate the biomechanical properties of transosseous RCR combined with the cinch stitch in the lateral row. We hypothesized that this construct would have better mechanical strength than would transosseous repair using a vertical cinch stitch or simple stitch. Study Design: Controlled laboratory study. Methods: Rotator cuff tears were simulated in 48 porcine shoulder specimens. The tears were repaired using 1 of 6 repair configurations: 2–simple stitch transosseous repair alone (group 2TO), with a vertical cinch stitch (group 2TO-VC), or with a horizontal cinch stitch (group 2TO-HC) or 4–simple stitch transosseous repair alone (group 4TO), with a vertical cinch stitch (group 4TO-VC), or with a horizontal cinch stitch (group 4TO-HC). All specimens were set at a 45° angle from the footprint and underwent cyclic loading from 10 to 160 N for 200 cycles, followed by a load-to-failure test at 10 mm/min. Results: During cyclic loading, all specimens in group 2TO and half of the specimens in group 2TO-VC failed by suture pullout. In the other groups, none of the specimens failed before 200 cycles. The yield load in group 2TO-HC was significantly greater than that in group 2TO-VC (261.43 vs 219.54 N, respectively; P < .05). There were significant differences between groups 4TO-HC and 4TO with regard to elongation (3.92 vs 5.68 mm, respectively), yield load (304.04 vs 246.94 N, respectively), and linear stiffness (63.44 vs 52.28 N/mm, respectively) (P < .01 for all). Group 4TO-HC also had shorter elongation and a superior yield load and linear stiffness compared with group 2TO-HC (P < .05 for all), and group 4TO-VC had shorter elongation and a stronger maximum load to failure and yield load than did group 2TO-VC (P < .05 for all). Conclusion: Increasing the number of medial simple stitches can prevent suture pullout. Adding the horizontal cinch stitch to the lateral row in transosseous repair can further improve biomechanical properties through a self-cinching mechanism. Clinical Relevance: Transosseous RCR with a horizontal cinch stitch in the lateral row may reduce the retear rate.
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Affiliation(s)
- Kentaro Ito
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Katsunobu Sakaguchi
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Hirosi Sekihata
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Naoki Sugita
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Yuho Kadono
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
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Şahin K, Şentürk F, Ersin M, Arzu U, Chodza M, Erşen A. Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial. Orthop J Sports Med 2021; 9:23259671211002482. [PMID: 33954223 PMCID: PMC8058806 DOI: 10.1177/23259671211002482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Şentürk
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Ersin
- Haseki Education Research Hospital, Istanbul, Turkey
| | - Ufuk Arzu
- Dr Yaşar Eryılmaz Doğubeyazıt State Hospital, Ağrı, Turkey
| | | | - Ali Erşen
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Thangarajah T, Lo IK, Sabo MT. Rotator cuff repair techniques: Current concepts. J Clin Orthop Trauma 2021; 17:149-156. [PMID: 33854942 PMCID: PMC8022250 DOI: 10.1016/j.jcot.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/04/2023] Open
Abstract
Arthroscopic rotator cuff repair is being performed by an ever-increasing number of surgeons. With an ageing population and growing patient expectations it is crucial that clinical outcomes are optimised. Anatomical reduction of the tendon back to its footprint with minimal tension contributes to this, but this can only be achieved if key biomechanical factors are taken into consideration. In this review of the technical aspects of a rotator cuff repair, we focus on: (1) patient positioning, (2) biomechanical principles, (3) optimal visualisation, and (4) repair techniques for both anterior and postero-superior tears.
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Affiliation(s)
- Tanujan Thangarajah
- University of Calgary, Department of Trauma and Orthopaedic Surgery, 2500 University Drive NW, Calgary, Alberta, 2N 1N4, Canada
| | - Ian K. Lo
- University of Calgary, Department of Trauma and Orthopaedic Surgery, 2500 University Drive NW, Calgary, Alberta, 2N 1N4, Canada
| | - Marlis T. Sabo
- SCRUBS Research Unit, Cumming School of Medicine, University of Calgary, Canada
- Corresponding author. 4448 Front St SE, Calgary, AB, T3M 1M4, Canada.
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Abstract
» Regardless of recent advances in rotator cuff repair techniques, the rate of unhealed or recurrent rotator cuff tears remains high, with most recurrent rotator cuff tears occurring within the first 6 months after surgery.
» Factors that can negatively affect tendon healing include older age, greater tear size, tendon retraction, and fatty infiltration. However, several clinical features that are often underestimated, including osteoporosis, diabetes, smoking, and hyperlipidemia, have proven to have an important influence on rotator cuff healing.
» Recent meta-analyses that evaluated studies with Level-I and Level-II evidence have shown an overall increase in retear rates after single-row repair compared with double-row repair. However, to our knowledge, there are no Level-I clinical studies comparing different double-row configurations and, to date, no double-row repair technique has proven to be superior to the others.
» The influence of postoperative rotator cuff healing on clinical outcomes is controversial. Although clinical differences may not be apparent in the short term, healed tendons have had better functional outcomes and greater strength in the midterm.
» In general, a period of immobilization for 2 to 4 weeks, depending on tear size, is recommended. Graded supervised rehabilitation has proven to facilitate tendon healing without associated stiffness compared with early unprotected range of motion.
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Affiliation(s)
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois
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Maia Dias C, Gonçalves SB, Completo A, Tognini M, da Silva MR, Mineiro J, Curate F, Ferreira F, Folgado J. Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model. J Exp Orthop 2021; 8:9. [PMID: 33537914 PMCID: PMC7859138 DOI: 10.1186/s40634-020-00321-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. METHODS A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size "repair box" using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. RESULTS Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. CONCLUSION Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.
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Affiliation(s)
- Carlos Maia Dias
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - António Completo
- TEMA, Department of Mechanical Engineering, University of Aveiro (UA), Aveiro, Portugal
| | | | | | | | - Francisco Curate
- Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Frederico Ferreira
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Paramasivam Meenakshi Sundaram P, Lee WWB, Sayampanathan AA, Tan HCA. Comparison of clinical outcomes between knotted and knotless double-row arthroscopic rotator cuff repairs: a meta-analysis. JSES Int 2020; 5:254-260. [PMID: 33681845 PMCID: PMC7910719 DOI: 10.1016/j.jseint.2020.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background The ideal rotator cuff repair technique should allow for a quick and simple arthroscopic application which provides both adequate biomechanical stability and an appropriate biological state with the intention of promoting eventual healing of tendon to bone. While the biomechanical superiority of double-row repairs including higher repair strength, reduced gap formation, and wider footprint restoration have been proven, controversy remains regarding the clinical benefits of knotless compared with knot tying techniques. Our study aims to review the available evidence in the literature comparing the clinical outcomes between knotted and knotless transosseous double-row rotator cuff repair techniques. Methods A systematic literature search via PubMed, Embase, and Scopus was conducted by 2 independent reviewers. Studies reporting clinical outcomes of arthroscopic rotator cuff repair using the double-row knotted and knotless surgical techniques were identified. Data were analyzed with Review Manager 5.3, using Mantel-Haenszel statistics with both fixed and random effect models. Results A total of 1144 studies were identified from our initial search. Based on our inclusion and exclusion criteria, 8 studies were eventually selected for our review. The selected studies were published between 2012 and 2018. Of the 8 studies, 3 reported level 2 evidence and 5 reported level 3 evidence. There were a total of 589 subjects. Our meta-analysis revealed that there were no significant differences in functional outcomes postoperatively when comparing Constant score (mean difference = −1.85, 95% confidence interval: −4.42 to 0.73), University of California at Los Angeles score (mean differences = −0.14, 95% confidence interval: −0.90 to 0.62), and American Shoulder and Elbow Surgeons score (mean differences = −2.19, 95% confidence interval: −5.55 to 1.17) between patients who underwent knotted and knotless rotator cuff repairs. Discussions and Conclusion Our review revealed no statistically significant difference in functional outcomes between knotted and knotless transosseous double-row techniques for arthroscopic rotator cuff repairs. To our knowledge, this is the first meta-analysis related to this topic. However, no level 1 studies were available for this review. Further studies related to this topic should focus on reporting level 1 evidence comparing the clinical outcomes of knotless and knotted techniques for double-row repairs.
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Affiliation(s)
| | - Wei Wen Bryan Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Freislederer F, Scheibel M. Arthroscopic Knotless-Anchor Rotator Cuff Repair. JBJS Essent Surg Tech 2020; 10:ST-D-19-00021. [PMID: 34055468 DOI: 10.2106/jbjs.st.19.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The most common type of rotator cuff lesion is a tear of the supraspinatus tendon, with arthroscopic rotator cuff repair representing an established treatment option1-3. Several double-row techniques have been described to achieve complete coverage of the rotator cuff footprint. Among these is the bridging, double-row, transosseous-equivalent rotator cuff repair, which has become one of the most popular techniques for its maximized contact area and initial fixation strength4-9. However, medial cuff failure is a common complication following this procedure9-14. To reduce medial strangulation and overall surgical time, all-knotless anchor repair has been introduced as an alternative technique15. The arthroscopic knotless, bridging, double-row, transosseous-equivalent technique is performed with the patient in the beach-chair position via lateral operative and viewing portals. A medial row of suture anchors is placed in the usual fashion. The tendon is then perforated twice per anchor with use of a suture-passer device, after which the suture limbs are bridged over the tendon and fixed in a lateral row of anchors. Excellent functional outcomes as well as satisfaction in >90% of patients have been reported with the supraspinatus knotted double-row, bridging, transosseous-equivalent repair4,9,11,13,16-19. No significant differences have been reported for clinical results and tendon integrity on magnetic resonance imaging when comparing knot-tying and knotless double-row transosseous-equivalent rotator cuff repair; however, the rate of medial cuff failure was lower among knotless procedures1,12,16,17,20-25. The major steps of the procedure, which are demonstrated in this video article, include (1) diagnostic arthroscopy; (2) supraspinatus tear visualization and debridement; (3) decortication of the footprint on the greater tuberosity; (4) placement of the medial row of anchors loaded with nonabsorbable suture tape; (5) separate suture passage of each limb, perforating the tendon with use of a suture passer; (6) fixation of the tape in the lateral row of anchors, creating a bridging configuration; and (7) anterolateral acromioplasty with use of an arthroscopic burr. Complications are rare following this procedure. As postoperative rehabilitation is essential for tendon healing, the operative arm should be placed in an abduction brace for 6 weeks, with only passive mobilization.
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Takeuchi Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Morioka T, Ueda Y, Hoshika S. Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying After Suture-Bridge Lateral Row Rotator Cuff Repair. Am J Sports Med 2020; 48:2510-2517. [PMID: 32663065 DOI: 10.1177/0363546520934786] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique. HYPOTHESIS This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up. RESULTS This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery (P < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups. CONCLUSION The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.
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Affiliation(s)
- Yasutaka Takeuchi
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Hiroyuki Sugaya
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Norimasa Takahashi
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Morihito Tokai
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Takeshi Morioka
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Yusuke Ueda
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Shota Hoshika
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
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Endo A, Hoogervorst P, Safranek C, Sochacki KR, Safran MR, Sherman SL, Donahue J. Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes. Orthop J Sports Med 2020; 8:2325967120938311. [PMID: 32728593 PMCID: PMC7366410 DOI: 10.1177/2325967120938311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs. Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05. Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively (P < .001). The QuickDASH (P < .001), SST (P < .001), and VAS (P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up. Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.
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Affiliation(s)
- Atsushi Endo
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
| | - Paul Hoogervorst
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
| | - Conrad Safranek
- Stanford University, Bioengineering, Stanford, California, USA
| | - Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Joseph Donahue
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
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Oh JH, Park JS, Rhee SM, Park JH. Maximum Bridging Suture Tension Provides Better Clinical Outcomes in Transosseous-Equivalent Rotator Cuff Repair: A Clinical, Prospective Randomized Comparative Study. Am J Sports Med 2020; 48:2129-2136. [PMID: 32551868 DOI: 10.1177/0363546520930425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some studies reporting clinical outcomes after transosseous-equivalent (TOE) repair have attributed type II rotator cuff failure to excessive bridging suture tension, as it can cause overloading on the medial row. In a previous biomechanical cadaveric study, increasing bridging suture tension over 90 N did not improve the contact area and ultimate failure load of the TOE construct, despite increasing the contact force and contact pressure. PURPOSE To compare the clinical outcomes of different bridging suture tensions after TOE rotator cuff repair based on the results of a previous biomechanical study. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 78 patients who underwent arthroscopic rotator cuff repair for medium- to large-sized tears were prospectively enrolled and randomly divided into 2 groups according to the applied bridging suture tension: optimum tension group (96.3 ± 4.9 N) and maximum tension group (199.0 ± 20.3 N). Bridging suture tension was measured with a customized tensiometer, as used in the previous biomechanical study. The functional outcome was measured at the final follow-up (27.4 ± 5.9 months [range, 24-45 months]) using the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Constant score, and the anatomic outcome was evaluated using magnetic resonance imaging or ultrasonography at least 12 months after surgery. RESULTS Overall, 64 patients (32 in each group) were analyzed. The functional outcomes improved significantly compared with preoperative values (all P < .05) but did not show significant differences between the 2 groups (all P > .05). Regarding the anatomic outcomes, the maximum tension group (n = 1; 3.1%) had a significantly lower healing failure rate than the optimum tension group (n = 9; 28.1%) (P = .013). One patient in the maximum tension group had a type II failure. CONCLUSION Maximum bridging suture tension in TOE repair for medium- to large-sized rotator cuff tears provided better anatomic healing with less risk of medial rotator cuff failure, which differs from the results of a previous time-zero biomechanical study.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | | | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joo Hyun Park
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Republic of Korea
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Kunze KN, Rossi LA, Beletsky A, Chahla J. Does the Use of Knotted Versus Knotless Transosseous Equivalent Rotator Cuff Repair Technique Influence the Incidence of Retears? A Systematic Review. Arthroscopy 2020; 36:1738-1746. [PMID: 32057983 DOI: 10.1016/j.arthro.2020.01.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare knotted and knotless transosseous equivalent (TOE) rotator cuff repair (RCR) techniques and evaluate their imaging-diagnosed retear rates. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008 to 2019), EMBASE (2008 to 2019), and Medline (2008 to 2019) were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, with the following search terms: rotator cuff repair AND (knotless OR knotted) AND transosseous; rotator cuff repair AND (knotless OR knotted or transosseous); rotator cuff repair AND ("suture bridge" OR "suture bridging"). Data pertaining to demographic characteristics, surgical techniques, retears, and patient-reported outcomes were extracted from each study. Rates and locations of retear were reported using ranges, and risks of bias and heterogeneity for each study were assessed. RESULTS A total of 7 studies (552 shoulders) were included. Patients had a weighted mean (± standard deviation) age of 60.5 ± 2.4 years with 27.8 ± 7.9-month follow-up. The incidence of retears ranged from 5.1% to 33.3% in patients treated with knotless TOE RCR, and the incidence for patients treated with knotted TOE RCR ranged from 7.5% to 25%. The incidence of type I retears ranged from 42.9% to 100% for patients treated with knotless TOE RCR and 20% to 100% for patients treated with knotted TOE RCR. The incidence of type II retears ranged from 0% to 57.1% in patients treated with knotless TOE RCR and 0% to 100% in patients treated with knotted TOE RCR. CONCLUSIONS The incidence and location of retears after knotless and knotted TOE RCR appear to be similar.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luciano A Rossi
- Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alexander Beletsky
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Maalouly J, Aouad D, Tawk A, El Rassi G. Modified Double-Row Suture Bridge Technique With Double-Row Biceps Tenodesis for Massive Rotator Cuff Tear. Arthrosc Tech 2020; 9:e829-e835. [PMID: 32577359 PMCID: PMC7301334 DOI: 10.1016/j.eats.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 02/03/2023] Open
Abstract
This article aims to describe a modification of the arthroscopic suture bridge technique for repair of a massive (>3 cm) rotator cuff tear. The method uses 2 medial anchors and 2 lateral anchors for rotator cuff repair, as well as double-row biceps tenodesis. This operative modification may impart better tendon healing and fewer rupture complications than the traditional double-row repair techniques.
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Affiliation(s)
| | | | | | - Georges El Rassi
- Address correspondence to Georges El Rassi, M.D., St Georges University Medical Center, Achrafieh, St Georges Street, Lebanon, Beirut.
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Stone AV, Luo TD, Sharma A, Danelson KA, De Gregorio M, Freehill MT. Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model. Orthop J Sports Med 2020; 8:2325967120914932. [PMID: 32426405 PMCID: PMC7218996 DOI: 10.1177/2325967120914932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory. Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. Study Design: Controlled laboratory study. Methods: A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing. Results: The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied (P = .15) and untied (P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor (P = .16) and double-loaded suture tape and anchor (P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied. Conclusion: An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors. Clinical Relevance: Both tied and untied medial rows demonstrated similar pressures across the repair construct.
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Affiliation(s)
| | - T David Luo
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Aman Sharma
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kerry A Danelson
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Mijares MR, Hiller A, Alhandi A, Kaimrajh D, Milne T, Latta L, Baraga MG. Is it necessary to tie the medial row in rotator cuff repair double-row constructs when using suture tape? J Clin Orthop Trauma 2020; 11:S378-S382. [PMID: 32523297 PMCID: PMC7275275 DOI: 10.1016/j.jcot.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/08/2020] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the selected biomechanical differences of a double-row trans-osseous equivalent rotator cuff repair with a knotless versus knot-tying medial row using suture tape in regard to repair displacement, stiffness, and ultimate load to failure. METHODS In 16 fresh-frozen human shoulders (8 matched pairs), double-row rotator cuff repairs were performed with medial-row mattress knots (MK) on one side, the other without (NK). Two DVRT (Differential Variable Reluctance Transducer) sensors were attached between the humerus and 3 mm above the repair site and were used to measure the displacement across the repair during cycling. The biomechanical parameters measured were repair displacement, stiffness, and ultimate load to failure. The supraspinatus was loaded in a similar fashion to previously described protocol using cyclic loading and load to failure testing.1. RESULTS All data from paired specimens were compared using paired Student t tests. No statistically significant difference (SSD) in displacement across the repair over the 200 cycles of the test was noted between the two groups (MK = 0.591 ± 0.501 mm; NK = 0.439 ± 0.417 mm, p = 0.618). No SSD in stiffness was noted between the two groups (MK = 32.87 ± 6.31 N/mm; NK = 27.98 ± 9.69 N/mm, p = 0.120). No SSD in ultimate load to failure was noted between the two groups (MK = 501.2 ± 126.1 N; NK = 416.8 ± 120.0 N, p = 0.116). CONCLUSION There was no statistically significant different between knotless versus knotted medial row double row rotator cuff repair constructs using suture tape in regard to displacement across the repair site, stiffness and ultimate load to failure. Despite previous evidence suggesting inferiority of knotless medial row technique using suture constructs, this evidence may support the biomechanical equivalency of knotless medial row technique using suture tape.
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Affiliation(s)
- Michael R. Mijares
- Department of Orthopaedics, University of Miami/Jackson Memorial Hospital, NW 12th Avenue, Suite 303, Miami, FL, 33136, USA,Corresponding author. University of Miami/Jackson Memorial Hospital, Department of Orthopaedics (D-27), Rehab Bldg, 1611 NW 12th Avenue, Suite 303, Miami, FL, 33136, USA.
| | - Andrew Hiller
- Department of Orthopaedics, Aventura Medical Center, 21097 NE 27th Ct, Aventura, FL, 33180, USA
| | - Ali Alhandi
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, 33140, USA
| | - David Kaimrajh
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, 33140, USA
| | - Ted Milne
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, 33140, USA
| | - Loren Latta
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, 33140, USA,Department of Orthopaedics, University of Miami, 1611 NW 12th Avenue, Suite 303, Miami, FL, 33136, USA
| | - Michael G. Baraga
- Department of Orthopaedics, University of Miami Sports Medicine Institute, 5555 Ponce De Leon Blvd, Coral Gables, FL, 33136, USA
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Abstract
Although open transosseous repair was historically used as a gold-standard surgical solution for rotator cuff tears, this procedure was largely replaced by anchor-based techniques because of the advancement of arthroscopic surgery. However, the ability of anchor-based repair to achieve similar biomechanical fixation remains uncertain. Despite the proposals of numerous methods over the last decade, there remains demand for a standard, reliable technique that integrates the biomechanical advantages of transosseous fixation within the realm of arthroscopy. We describe a technique for transosseous rotator cuff repair using the Omnicuff, a needle-based transosseous suture-passing device that minimizes the risk of failure of suture passage between the bone tunnels. With potential advantages of this design including automated-assisted suture passage, improved bone-tendon healing, and anchorless fixation, surgeons may be inclined to consider these biomechanical and cost-saving benefits. Future studies are warranted to determine clinical outcomes of this technique and its suitability for tears of varying degrees and patterns.
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Heuberer PR, Pauzenberger L, Gruber MS, Kriegleder B, Ostermann RC, Laky B, Anderl W. The knotless cinch-bridge technique for delaminated rotator cuff tears leads to a high healing rate and a more favorable short-term clinical outcome than suture-bridge repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3920-3928. [PMID: 31062044 DOI: 10.1007/s00167-019-05519-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare functional outcomes and magnetic resonance image (MRI) tendon integrity following either the suture bridge or the knotless cinch-bridge technique used for arthroscopic double-layer rotator cuff repair. METHODS 37 prospectively enrolled patients (46-76 years), who were treated with arthroscopic double-layer rotator cuff repair (group 1: suture bridge n = 20, group 2: cinch bridge n = 17) were clinically and radiographically assessed before and at an average of 24.0 ± 4.7 months after the procedure. Shoulder function was evaluated by the constant score (CS), range of motion, and various patient-related scores. Repaired tendon integrity was evaluated by MRI. Peri- and postoperative complications were recorded. RESULTS All functional and patient-related scores significantly improved from pre- to postoperative. Significantly better postoperative CS (P = 0.037), flexion (P < 0.001), and abduction (P = 0.009) were detected after arthroscopic cinch compared to suture-bridge repair. The mean CS improvements from baseline to follow-up were not significantly different between the groups (n.s.). Patient-related scores did not show any statistical significant differences. The MRI healing rate following arthroscopic double-layer repair with the suture- and cinch-bridge technique was 95% and 94%, respectively. Fatty infiltration regarding the supraspinatus and infraspinatus increased in 55% and 35% (group 1) and in 53% and 48% (group 2), respectively. Muscle hypotrophy remained stable in all patients. Overall, 92% of the patients were very satisfied or satisfied with the procedure. No complications were detected. CONCLUSIONS Arthroscopic knotless double-layer rotator cuff repair with the cinch-bridge technique showed higher CS, forward flexion, and abduction values, as well as similar patient-related short-term outcome and MRI integrity compared to the suture-bridge technique. These results highlight the potential importance of less tendon strangulation for better clinical short-term outcome. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Philipp R Heuberer
- , Health Pi, Wollzeile 1-3, 1010, Vienna, Austria. .,Vienna Shoulder and Sports Clinic, Vienna, Austria. .,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria.
| | | | | | | | | | - Brenda Laky
- Vienna Shoulder and Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Werner Anderl
- Vienna Shoulder and Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
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Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthop J Sports Med 2019; 7:2325967119868674. [PMID: 31565664 PMCID: PMC6755640 DOI: 10.1177/2325967119868674] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is substantial evidence indicating that double-row (DR) repair restores
more of the anatomic rotator cuff footprint and is biomechanically superior to
single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown
biomechanical advantages when compared with traditional DR, including increased
contact at the rotator cuff footprint, higher pressure at the tendon-bone
interface, and increased failure strength. Several meta-analyses of evidence
level 1 and 2 studies have shown a lower rate of failed/incomplete healing when
DR repair was compared with SR repair types. There is some limited evidence that
TOE techniques improve healing rates in large and massive tears as compared with
SR and DR. Overall, most level 1 and 2 studies have failed to prove a
significant difference between SR and DR repairs in terms of clinical outcomes.
However, most studies include only short-term follow-up, minimizing the impact
that the higher rate of retears/failed healing seen with SR repairs can have in
the long term. There are no high-quality clinical studies comparing different DR
configurations, and there are currently not enough clinical data to determine
the functional advantages of various DR technique modifications over one
another. Although numerous biomechanical and clinical studies comparing
different rotator cuff repair techniques have been published in the past decade,
none has achieved universal acceptance. It is essential for the orthopaedic
surgeon to know in detail the available literature to be able to apply the most
appropriate and cost-effective technique in terms of healing and functional
outcomes. This review provides a critical analysis of the comparative
biomechanical and clinical studies among SR, DR, and TOE techniques reported in
the literature in the past decade.
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Affiliation(s)
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes. Arthroscopy 2019; 35:2749-2755. [PMID: 31500765 DOI: 10.1016/j.arthro.2019.02.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Abstract
The primary aim of rotator cuff repair surgery is to restore the musculotendinous units by creating a complete, tension-free repair construct that optimizes conditions for tendon-to-bone healing. There are many factors outside the control of the surgeon that are capable of affecting the healing process; however, there are also a number of important technical considerations that the surgeon can control, including familiarity with methods to deal with immobile tissues and techniques to perform novel repair constructs. It is clear that linked double row repairs are more likely to heal, and healed rotator cuff repairs best restore shoulder strength, improve patients' satisfaction, and maximize functional outcomes.
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Dukan R, Ledinot P, Donadio J, Boyer P. Arthroscopic Rotator Cuff Repair With a Knotless Suture Bridge Technique: Functional and Radiological Outcomes After a Minimum Follow-Up of 5 Years. Arthroscopy 2019; 35:2003-2011. [PMID: 31147110 DOI: 10.1016/j.arthro.2019.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiological outcomes of knotless suture bridge repair after a minimum of 5 years of follow-up. METHODS 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 5 years with magnetic resonance imaging (MRI) at 24 months 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 24 months. 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. RESULTS Sixty-eight patients were included in this series. Mean follow-up was equal to 68.8 ± 7 months. 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. CONCLUSIONS 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 OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ruben Dukan
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France.
| | - Pauline Ledinot
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
| | - Julia Donadio
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
| | - Patrick Boyer
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
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Elbuluk AM, Coxe FR, Fabricant PD, Ramos NL, Alaia MJ, Jones KJ. Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair? Orthop J Sports Med 2019; 7:2325967119842881. [PMID: 31205960 PMCID: PMC6537075 DOI: 10.1177/2325967119842881] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have
been widely accepted because of their superior biomechanical properties when
compared with arthroscopic single-row repair. Concerns regarding repair
overtensioning with medial-row knot tying have led to increased interest in
knotless repair techniques; however, there is a paucity of clinical data to
guide the choice of technique. Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will
demonstrate lower retear rates and greater improvements in the Constant
score relative to conventional knot-tying TOE techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was
performed using PRISMA (Preferred Reporting Items for Systematic
Meta-Analyses) guidelines. Inclusion criteria were English-language studies
that examined repair integrity or Constant scores after arthroscopic rotator
cuff repair with TOE techniques. Two investigators independently screened
results for relevant articles. Data regarding the study design, surgical
technique, retear rate, and Constant shoulder score were extracted from
eligible studies. A quality assessment of all articles was performed using
the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The systematic review identified a total of 32 studies (level of evidence,
1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5
reported on knotless TOE techniques, 25 reported on knot-tying TOE
techniques, and 2 reported on both. In the knotless group, retear rates
ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative)
to 73-83 (postoperative). In the knot-tying group, retear rates ranged from
0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96
(postoperative). Conclusion: Despite several theoretical advantages of knotless TOE repair, both knotless
and knot-tying techniques reported considerable improvement in functional
outcomes after rotator cuff repair. Although tendon failure rates showed a
downward trend in knotless studies, additional prospective studies are
warranted to better understand the role of medial-row fixation on tendon
repair integrity and postoperative clinical outcomes.
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Affiliation(s)
| | | | | | - Nicholas L Ramos
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Ren YM, Zhang HB, Duan YH, Sun YB, Yang T, Tian MQ. Comparison of arthroscopic suture-bridge technique and double-row technique for treating rotator cuff tears: A PRISMA meta-analysis. Medicine (Baltimore) 2019; 98:e15640. [PMID: 31096482 PMCID: PMC6531199 DOI: 10.1097/md.0000000000015640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rotator cuff tear is a common shoulder disorder in the elderly. Either arthroscopic double-row (DR) or suture-bridge (SB) technique for rotator cuff tear patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic SB versus DR intervention. METHODS The 7 studies were acquired from PubMed, Medline, Embase, CNKI, Google, and Cochrane Library. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa scale were used to assess risk of bias. RESULTS Seven studies including 1 randomized controlled trial and 6 observational studies were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion showed that the differences were not statistically significant between the 2 interventions. The difference of University of California at Los Angeles (UCLA) score was statistically significant between SB and DR intervention, and SB treatment was more effective (MD = -0.95, 95% CI = -1.70 to -0.20, P = .01). The difference of re-tear rate was statistically significant and SB treatment achieved better result than DR treatment (OR = 0.31, 95% CI = 0.15-0.64, P = .001). Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent. CONCLUSIONS Both arthroscopic SB and DR interventions had benefits in rotator cuff tear. SB treatment was more effective in UCLA score and had lower re-tear rate than DR treatment. The arthroscopic SB technique is recommended as the optical choice for rotator cuff tear.
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Affiliation(s)
- Yi-Ming Ren
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Hong-Bin Zhang
- Department of Orthopedics, People's Hospital of Jinxiang County, Jinxiang, Shandong Province
| | - Yuan-Hui Duan
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Yun-Bo Sun
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Tao Yang
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Meng-Qiang Tian
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
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Uchida A, Mihata T, Neo M. Subacromial bone erosion due to suture-knots in arthroscopic rotator cuff repair: A report of two cases. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 16:30-35. [PMID: 30984561 PMCID: PMC6445400 DOI: 10.1016/j.asmart.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022]
Abstract
Knot impingement can cause shoulder-joint motion pain after rotator-cuff repair. Previous studies have revealed only subacromial effusion in magnetic resonance imaging (MRI) evaluations of knot impingement. We report two cases of patients with symptomatic knot impingement. In both patients, bursal-side partial-thickness tear of the supraspinatus tendon had been repaired by a single-row technique using one suture anchor and two polyester sutures with a long-chain polyethylene core. Three-dimensional computed tomography and arthroscopy revealed bony erosion at the lateral side of the anterior half of the acromial undersurface in both patients. The size of the erosion was 1.7 cm (anteroposterior direction) × 0.7 cm (mediolateral direction) in one patient and 1.2 cm × 0.5 cm in the other. Arthroscopy showed that suture knots that had been placed at the muscle-tendon junction of the supraspinatus tendon were impinging on the area of bone erosion during shoulder abduction. Although the sutures themselves were of soft material, knot-tying made them stiff and thus led to bone erosion. Surgeons need to be aware of the possibility of subacromial bone erosion caused by suture knots in arthroscopic rotator cuff repair.
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Affiliation(s)
- Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Aydin N, Karaismailoglu B, Gurcan M, Ozsahin MK. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J 2018; 4:57. [PMID: 30547879 PMCID: PMC6294008 DOI: 10.1051/sicotj/2018048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations. When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness. It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.
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Affiliation(s)
- Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Mert Gurcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Bedeir YH, Schumaier AP, Abu-Sheasha G, Grawe BM. Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:373-382. [PMID: 30229445 DOI: 10.1007/s00590-018-2306-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/11/2018] [Indexed: 01/22/2023]
Abstract
AIM/PURPOSE To provide a systematic review of the literature on patterns of retear after single-row (SR), double-row (DR) and suture bridge (SB) techniques. METHODS The PubMed and MEDLINE databases were searched for published articles reporting both repair technique and retear pattern. Studies in languages other than English, those reporting open rotator cuff repair as the index procedure, as well as animal and cadaveric studies and those which did not describe patterns of retear, were excluded. MINORS scoring system was used to quantify potential bias in each study. Retears were classified into type 1 (failure at the tendon-bone interface) and type 2 (medial cuff failure). For all studies included, number and type of retears after different repair techniques were reported and analyzed. RESULTS Fourteen studies were included yielding a total of 260 rotator cuff retears. Repair technique had a significant impact on the estimated incidence rate of type 2 retear (p = .001). The estimated incidence rate of type 2 retear was 24% with SR (95% CI 14-38%), 43% with DR (95% CI 22-66%), 62% with SB (95% CI 54-70%) and 38% with SB (95% CI 23-57%). CONCLUSION Despite the lack of high-quality evidence, this study suggests that DR and SB techniques increase the risk of medial cuff failure. Modifications in surgical techniques in both DR and SB repairs can help decrease that risk. LEVEL OF EVIDENCE Level IV, systematic review of investigations including level IV.
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Affiliation(s)
- Yehia H Bedeir
- Department of Orthopaedic Surgery, Sports Medicine Division, University of Cincinnati Medical Center, 200 Albert Sabin Way, Cincinnati, OH, 45220, USA. .,Department of Orthopaedic Surgery, El-Hadara University Hospital, University of Alexandria Medical Center, Alexandria, Egypt.
| | - Adam P Schumaier
- Department of Orthopaedic Surgery, Sports Medicine Division, University of Cincinnati Medical Center, 200 Albert Sabin Way, Cincinnati, OH, 45220, USA
| | - Ghada Abu-Sheasha
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| | - Brian M Grawe
- Department of Orthopaedic Surgery, Sports Medicine Division, University of Cincinnati Medical Center, 200 Albert Sabin Way, Cincinnati, OH, 45220, USA
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Kim KC, Shin HD, Lee WY, Yeon KW, Han SC. Clinical outcomes and repair integrity of arthroscopic rotator cuff repair using suture-bridge technique with or without medial tying: prospective comparative study. J Orthop Surg Res 2018; 13:212. [PMID: 30153852 PMCID: PMC6114704 DOI: 10.1186/s13018-018-0921-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 01/23/2023] Open
Abstract
Background There have been few studies comparing clinical and radiological outcomes between the conventional and knotless suture-bridge techniques. The purpose of this study was to evaluate and compare the functional outcomes and repair integrity of arthroscopic conventional and knotless suture-bridge technique for full-thickness rotator cuff tears. Methods We prospectively followed 100 consecutive patients (100 shoulders) with full-thickness rotator cuff tears treated with the arthroscopic conventional or knotless suture-bridge technique from October 2012 to July 2014. Enrolled patients returned for follow-up functional evaluations at 1 and 2 years after the operation. There were four outcome measures in this study: American Shoulder and Elbow Surgeons (ASES) scores, Shoulder Rating Scale of the University of California at Los Angeles (UCLA) scores, Constant scores, and visual analog scale (VAS) pain scores. Enrolled patients returned for follow-up magnetic resonance imaging or ultrasonography evaluation to confirm the integrity of the repaired cuff at 6 months post-operation (97% follow-up rate). Also, we investigated the preoperative cuff retraction of enrolled patients using preoperative MRI to find out correlation between the stage of cuff retraction and re-tear rate. Results At final follow-up, the average UCLA, ASES, Constant, and VAS scores had improved significantly to 32.5, 88.0, 80.4, and 1.3, respectively, in the conventional suture-bridge technique group and to 33.0, 89.7, 81.2, and 1.2, respectively, in the knotless suture-bridge technique group. The UCLA, ASES, Constant, and VAS scores improved in both groups after surgery (all p < 0.001), and there were no significant differences between the two groups at 2-year follow-up (p = 0.292, 0.359, 0.709, and 0.636, respectively). The re-tear rate of repaired rotator cuffs was 16.3% (8/49 shoulders) in the conventional suture-bridge technique group and 29.2% (14/48 shoulders) in the knotless suture-bridge technique group; this difference was not significant (p = 0.131). There were no significant differences between the re-tear rate of the two groups in the Patte stage I and II (p = 0.358 and 0.616). Conclusions The knotless suture-bridge technique showed comparable functional outcomes to those of conventional suture-bridge techniques in medium-to-large, full-thickness rotator cuff tears at short-term follow-up. The knotless suture-bridge technique had a higher re-tear rate compared with conventional suture-bridge technique, although the difference was not significant.
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Affiliation(s)
- Kyung Cheon Kim
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - Kyu-Woong Yeon
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| | - Sun-Cheol Han
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
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Denard PJ, Adams CR, Fischer NC, Piepenbrink M, Wijdicks CA. Knotless Fixation Is Stronger and Less Variable Than Knotted Constructs in Securing a Suture Loop. Orthop J Sports Med 2018; 6:2325967118774000. [PMID: 29845084 PMCID: PMC5964856 DOI: 10.1177/2325967118774000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Historically, tendon-to-bone fixation has relied on knot tying. However, considerable variability exists in knot-tying strength among surgeons. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical properties of knotted and knotless fixation and to evaluate variability among surgeons. The hypothesis was that knotless constructs would be stronger and have less variability as compared with knotted constructs. Study Design: Controlled laboratory study. Methods: A total of 34 orthopaedic surgeons participated in a laboratory study to compare knotted and knotless constructs, where 104 knotted constructs were performed with No. 2 suture, 21 knotless constructs with No. 2 suture (K2 group), and 79 knotless constructs with suture tape (KT group). Mechanical testing was performed to compare load at 3 mm of displacement, load to failure, and stiffness of each construct. Results: The mean load at 3 mm of displacement was greatest in the KT group, with significant differences among all 3 groups (P < .001). Load to failure was significantly greater in the KT group as compared with the K2 group and the knotted group (P < .001), but there was no difference between the K2 and knotted groups (P ≥ .999). Stiffness and displacement were also greatest in the KT group. Based on the F test, the variance in load to failure was significantly different between the knotted and knotless constructs, with the knotted group demonstrating greater variability (SD, 94 N) than the KT (SD, 38 N) and K2 (SD, 17 N) groups (P < .001). Conclusion: Knotless fixation with suture tape had improved biomechanical performance as compared with knots or knotless fixation with No. 2 suture. In addition, knotless fixation had less variability in biomechanical properties among multiple surgeons. Clinical Relevance: This study may be relevant for surgeons choosing between knotted and knotless constructs as well as for considerations in the design of rotator cuff repair constructs.
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Affiliation(s)
| | - Christopher R Adams
- Naples Community Hospital Healthcare System, Naples, Florida, USA.,Department of Medical Education, Arthrex Inc, Naples, Florida, USA
| | - Nicole C Fischer
- Department of Research and Development, Arthrex GmbH, Munich, Germany
| | | | - Coen A Wijdicks
- Department of Research and Development, Arthrex GmbH, Munich, Germany
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Abstract
This present article summarizes established and current developments and aspects of rotator cuff surgery. Achieved milestones as well as current approaches are presented and assessed with respect to their clinical and radiographic impact. Despite biomechanical and technical improvements in modern rotator cuff repair techniques, re-defect and re-tearing rates could not be fully eliminated. Meanwhile, the importance of biological processes around successful tendon-bone reintegration has been increasingly recognized. Hence, this article presents the current scientific standing regarding biological growth factors, platelet-rich plasma and rotator cuff augmentation techniques (with allogenic/autologous grafts). In summary, there are clear biomechanical advantages as well as many promising approaches to biological augmentation; however, the latter have not yet been transferred into regular clinical application.
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Heuberer PR, Pauzenberger L, Smolen D, Ostermann RC, Anderl W. An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge. Arthrosc Tech 2017; 7:e7-e12. [PMID: 29379708 PMCID: PMC5785949 DOI: 10.1016/j.eats.2017.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff repairs are the most common procedures in shoulder surgery, but still show long-term retear rates of up to 70%. Nonanatomic reconstruction is one possible cause of repair failure. The rotator cuff histologically consists of 5 separate layers of which 2 are macroscopically identifiable: the superior or tendinous layer and the inferior or capsule-ligamentous layer. In case of rotator cuff tears, these layers are often retracted to different degrees. The intraoperative detectable prevalence of rotator cuff delamination reaches up to 85%. Anatomical rotator cuff repair, which also includes restoration of the layered structure, could re-establish native tendon morphology and thus potentially decreases retear rates. The use of a knotless construct to avoid cuff strangulation and maintaining tendon perfusion could further decrease the risk of repair failure. Double-layer reconstructions are challenging and time consuming because each layer needs to be penetrated separately. Only few studies reported about double-layer reconstruction of the posterosuperior rotator cuff. This Technical Note is the first to present an arthroscopic knotless transosseous-equivalent double-layer repair technique.
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Affiliation(s)
- Philipp R. Heuberer
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria,Address correspondence to Philipp R. Heuberer, M.D., St. Vincent Shoulder & Sports Clinic, Baumgasse 20A, A-1030 Vienna, Austria.St. Vincent Shoulder & Sports ClinicBaumgasse 20AA-1030 ViennaAustria
| | - Leo Pauzenberger
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Daniel Smolen
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Roman C. Ostermann
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Werner Anderl
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
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