Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair?

What is the Optimal Construct to Reduce Failure in Arthroscopic Four Anchor Rotator Cuff Repair?

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.

Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis

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.

Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair

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.

Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

BACKGROUND

Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons.

METHODS

A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair.

RESULTS

Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination.

CONCLUSION

Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

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]

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.

Modified double-pulley suture-bridge techniques with or without medial knot tying show comparable clinical and radiological outcomes in arthroscopic rotator cuff repair

PURPOSE

The optimal technique for arthroscopic rotator cuff repair is still controversial. The aim of this study was to compare modified arthroscopic double-pulley suture-bridge (DPSB) technique with medial knot tying to those without tying, considering clinical and radiological outcomes.

METHODS

This study included 292 patients with large full-thickness rotator cuff tears treated with modified DPSB technique. The patients were divided into 158 cases with medial knot tying (knot-tying group) and 134 without tying (knotless group). At follow-up, clinical outcome was assessed by the Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score. The assessment of tendon healing was performed with magnetic resonance imaging (MRI) at a minimum of 12 months postoperatively.

RESULTS

The Constant score, ASES score and UCLA score in the knot-tying and knotless groups all improved significantly from before surgery to 12 months postoperatively (P < 0.05, respectively). No significant differences were observed between groups for each phase evaluated (n.s.). Tendon healing was categorised according to Sugaya's classification. The retearing rate was 27/158 (17.0%) in the knot-tying group and 20/134 (14.9%) in the knotless group, with no statistically significant difference between groups (n.s.). Additionally, the retear was classified using the Cho's classification. When comparing the retear rates of different types independently, no statistically significant differences were found between groups (n.s.).

CONCLUSIONS

The knotless modified DPSB technique showed comparable short-term functional outcomes to those of the knot tying method in large full-thickness rotator cuff tears. Additionally, no significant differences in repair integrity were observed between the two methods. Both techniques can be considered effective treatments for patients with large-sized full-thickness rotator cuff tears.

LEVEL OF EVIDENCE

III.

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

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

Repair Tension During Arthroscopic Rotator Cuff Repair is Correlated With Preoperative Tendon Retraction and Postoperative Rotator Cuff Integrity

PURPOSE

This study aimed to examine the correlation of repair tension during arthroscopic rotator cuff repair (ARCR) with preoperative factors and to evaluate whether measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR.

METHODS

Patients who underwent ARCR from May 2014 to June 2017 were enrolled in this study. Inclusion criteria were patients with medium or larger-sized tears and with a minimum of 6 months' follow-up. Patients with a partial repair were excluded. Intraoperative repair tension was measured according to Davidson's method. Correlation of repair tension with preoperative factors was evaluated with Pearson and Spearman correlation coefficient tests. Logistic regression analysis was performed on intraoperative factors, including repair tension, to identify independent predictors of retear after ARCR. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of repair tension for retear.

RESULTS

One-hundred twenty patients met the inclusion criteria. Mean repair tension was 26.6 ± 12.6 N, and retear was found in 29 shoulders (24.2%). Among the preoperative factors, tear size in the mediolateral (P < .001) and anteroposterior (P < .001) directions, DeOrio and Cofield's classification (P <0.001), geometric classification (P <.001), and fatty infiltration of supraspinatus (P = .006) and infraspinatus (P = .003) were significantly correlated with repair tension. However, multivariable logistic regression analysis identified only tear size in the mediolateral direction as an independent predictor of repair tension (P = .036). Logistic regression analysis showed that repair tension (P = .02) and geometric classification (P < .001) are significant factors affecting rotator cuff integrity after ARCR. ROC curve analysis showed the cutoff value of repair tension of large to massive tears for retear to be 35.6 N.

CONCLUSION

This study demonstrated that intraoperative repair tension is strongly correlated with tear size in the mediolateral direction based on preoperative magnetic resonance imaging and that measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR.

LEVEL OF EVIDENCE

Level IV, prognostic study.

Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair

PURPOSE

The Stump classification is significantly correlated with a retear after arthroscopic rotator cuff repair. However, no study has evaluated whether or not the stump classification is correlated with retear in the suture-bridge or double-row repair techniques. The aim of this study was to evaluate the relationship between a retear and the stump classification in the suture-bridge and double-row repair techniques.

METHODS

Among 389 patients who underwent arthroscopic repairs of full-thickness rotator cuff tears using suture-bridge or double-row repair techniques, 326 patients (median age 67.0 years; range 25-85) were included. There were 51 small, 172 medium, 83 large, and 20 massive tears. Two hundred forty patients were treated with the suture-bridge technique, and 86 patients were treated with the double-row technique. The following variables were analyzed: age, sex, the Cofield classification, anteroposterior and mediolateral tear size on preoperative MRI, global fatty degeneration index, and the stump classification. Cuff integrity was evaluated on magnetic resonance imaging at 6 months after surgery. The patients were divided into the intact and retear groups and the relationship between the variables and retear was evaluated by multivariate logistic regression analysis.

RESULTS

The overall retear rate was 10.1%. In the multivariate logistic regression analysis, the independent predictors of a retear were the stump classification type 3 (Odds ratio: 4.71, p = 0.0246), global fatty degeneration index (Odds ratio: 3.87, p = 0.0030), and anteroposterior tear size (Odds ratio: 1.07, p = 0.0077) in the suture bridge technique. In the double-row technique, the independent predictors of retear were stump classification type 3 (Odds ratio: 7.82, p = 0.0348), and age (Odds ratio: 1.22, p = 0.0163).

CONCLUSION

The stump classification was significantly correlated with retear in the suture-bridge and double-row repair technique. Stump classification type 3 was indicated to be an important risk factor for predicting retear.

LEVEL OF EVIDENCE

III.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

BACKGROUND

Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported.

PURPOSE

To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair.

STUDY DESIGN

Case series; Level of evidence 4.

METHODS

The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery.

RESULTS

A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years.

CONCLUSION

Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.

Two Techniques for Treating Medium-Sized Supraspinatus Tears: The Medially Based Single-Row Technique and the Suture Bridge Technique

Background

Arthroscopic rotator cuff repair emerged in the early 1990s, and the single-row repair technique (i.e., suture anchor[s] set at the center or laterally on the greater tuberosity) has shown promising outcomes; however, the healing rate of the repaired cuff is suboptimal. Although small to medium-sized rotator cuff tears have shown better clinical outcomes and structural healing than larger tears, healing failure still occurs¹.There are several factors that affect rotator cuff healing. The initial stiffness and strength of the repair, gap formation resistance, footprint coverage at the end of surgery, vascularity of the cuff, and mechanical stress on the repaired cuff are important factors². To improve tendon-to-bone healing, 2 repair techniques have been developed: the suture bridge technique and the medially based single-row technique. The suture bridge technique involves placing anchors in a 2-row fashion, with medial-row sutures from the medial anchors bridged over the footprint with lateral-row knotless anchors³. The single-bridge technique has shown biomechanical superiority in terms of ultimate strength, stiffness, and gap formation resistance⁴; however, these outcomes are achieved at the cost of relatively high tension at the suture-cuff junction, as well as interference with vascularity at the medial mattress sutures if medial mattress sutures are tied.Alternatively, the medially based single-row technique was proposed as a modification of the laterally based (traditional) single-row technique⁵. This technique is combined with the creation of bone marrow vents (microfracture technique) lateral to the inserted anchor in the footprint to promote soft-tissue regeneration (called "neotendon") over the exposed footprint. The theoretical advantages of this technique include lower tension on the repaired cuff; better screw purchase beneath the subchondral bone, which avoids weaker cancellous bone on the peripheral area of the greater tuberosity; and avoidance or reduction of lateral shift of the muscle-tendon junction. However, these outcomes are achieved with relatively weaker initial fixation strength and by exposing the uncovered greater tuberosity footprint lateral to the repaired tendon edge.Both procedures provide equivalent outcomes as measured by functional and pain scores. At present, there is no decisive superiority in treating small to medium-sized supraspinatus tears.

Description

Arthroscopic subacromial decompression is performed in both techniques.For suture bridge fixation, the suture anchor is placed at the articular margin of the humeral head as the medial row, and both limbs of each suture are passed through the tendon approximately 5 mm lateral to the muscle-tendon junction of the rotator cuff in a mattress fashion. After the medial-row knots are tied, the suture limbs are brought into 2 lateral push-in anchors.For the medially based single-row repair, suture anchors are placed lateral to the articular margin. Each suture limb is passed through the tendon approximately 1 cm medial to the torn edge of the cuff. All sutures are tied with 7 half-hitches, avoiding a sliding knot.

Alternatives

Open or mini-open rotator cuff repair⁶.Arthroscopic rotator cuff repair suture bridge technique without knot-tying⁷.Arthroscopic transosseous (i.e., anchorless) rotator cuff repair⁸.

Rationale

The suture bridge technique has achieved better mechanical properties and footprint coverage, and the medially based single-row technique has achieved lower tension on the repaired construct with neotendon regeneration. These techniques are the opposite concept as coverage-oriented and tension-oriented techniques, respectively. To our knowledge, there is presently no study showing that either of these 2 techniques is better than the other⁴. With that said, the author prefers the medially based single-row technique in cases with degenerative tendon tissue, especially among elderly patients with relatively short tendon substance and with preoperative stiffness because lowering the tension on the repaired construct would be more important than coverage of the greater tuberosity.

Expected Outcomes

Published data have not shown significant differences in the clinical outcomes and cuff integrity between these 2 techniques, with no decisive superiority when treating small to medium-sized supraspinatus tears. The choice between these techniques is solely the decision of the surgeon; however, medial cuff failure has been reported only when using the suture bridge technique, and incomplete healing was more frequent among medially based single-row techniques. One should consider the risks of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears.

Important Tips

The proposed risk factors for medial cuff failure in the suture bridge technique include:○ A mattress suture configuration placed at the muscle-tendon junction○ Aggressive rehabilitation○ Use of a large-diameter suture passer○ Application of a sliding knot○ High-stress concentration around the medial knotsThe proposed risk factors for incomplete healing in the medially based single-row techniqueare:○ Lower mechanical properties (initial stiffness and strength, gap formation resistance) in the repaired site○ Lower number of sutures.

Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure

BACKGROUND

Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far.

PURPOSE

To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions-(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction-using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair.

RESULTS

The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N (P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N (P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group (P≤ .029).

CONCLUSION

While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon.

CLINICAL RELEVANCE

DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.

Preoperative Lymphocyte to Monocyte Ratio Can Be a Prognostic Factor in Arthroscopic Repair of Small to Large Rotator Cuff Tears

BACKGROUND

Complete arthroscopic repair can treat small to large rotator cuff tears (RCTs) with good outcomes; however, the repair might be compromised by inflammation.

PURPOSE

To investigate the prognostic value of preoperative lymphocyte to monocyte ratio (LMR), a marker of systemic inflammation before surgery, in arthroscopic rotator cuff repair.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Between January 2014 and January 2016, primary small to large RCTs without stiffness, significant muscle fatty infiltration, or atrophy were completely repaired in 110 consecutive patients and followed. Preoperative LMR was obtained from blood routinely examined 1 day before surgery. Descriptive data and pre- and intraoperative variables were collected. Correlation analysis and multivariable linear regression analysis were used to determine the relationship between preoperative LMR and recovery including American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Fudan University Shoulder Score (FUSS), visual analog scale (VAS) score for pain, and range of motion (ROM). Poor recovery was defined as ASES score <80, shoulder stiffness as external rotation ≤20°, and pain as VAS score >3. The predictive value of preoperative LMR was determined by receiver operating characteristic (ROC) curve.

RESULTS

A total of 99 patients (101 shoulders) were followed for 2.88 ± 0.43 years. Overall, mean ASES, Constant-Murley, FUSS, and VAS scores were significantly improved at the final follow-up; however, 27 cases had either ASES <80, shoulder stiffness, pain, or a combination of these. Correlation analysis and multivariable linear analysis showed that preoperative LMR was the only factor independently associated with functional recovery, pain, and ROM. Patients with poor recovery had lower preoperative LMR than those with good recovery. Based on the ROC curve, the cutoff value of preoperative LMR was 4.760. Patients with preoperative LMR <4.760 had significantly inferior clinical outcomes compared with their counterparts. The corresponding specificity was 0.542, and sensitivity was 0.779.

CONCLUSION

Arthroscopic repair for small to large RCTs yielded good outcomes; however, some patients still had inferior functional scores, shoulder stiffness, or pain, which correlated with the level of preoperative systemic inflammation. As a marker of systemic inflammation, preoperative LMR could be prognostic for rotator cuff repair.

Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques

OBJECTIVE

This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques.

METHODS

Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear.

CONCLUSION

In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term.

LEVEL OF EVIDENCE

Level III, Therapeutic study.