Background: Only a few studies have examined repair integrity and functional outcome after arthroscopic suture-bridge rotator cuff repair procedure. In addition, no reported study has compared outcomes between the suture-bridge and double-row techniques.
Purpose: This study compared the functional outcome and repair integrity of arthroscopic double-row and conventional suture-bridge repair in full-thickness rotator cuff tears.
Study Design: Cohort study; Level of evidence, 2.
Methods: Fifty-two consecutive full-thickness rotator cuff tears with 1 to 4 cm of anterior to posterior dimension that underwent arthroscopic rotator cuff repair were included. A double-row technique was used in the first 26 consecutive shoulders, and a conventional suture-bridge technique was used in the next 26 consecutive shoulders. Fifty shoulders (92.5%) underwent magnetic resonance imaging or ultrasonography postoperatively. Clinical outcomes were evaluated a minimum 2 years (mean, 37.2 months; range, 24-54) postoperatively using the University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and Constant scores. The postoperative cuff integrity was evaluated a mean of 33.0 (range, 10-54) months postoperatively.
Results: At the final follow-up, the average UCLA, ASES, and Constant scores improved significantly, to 32.3, 90.5, and 80.7, respectively, in the double-row group and to 30.6, 88.5, and 74.0, respectively, in the suture-bridge group. The UCLA, ASES, and Constant scores improved in both groups postoperatively (all P < .001); however, there was no significant difference between the 2 groups at final follow-up (P = .185, .585, and .053, respectively). The retear rate was 24% in the shoulders that underwent double-row repair and 20% in the shoulders that underwent suture-bridge repair; this difference was not statistically significant (P = .733).
Conclusion: The arthroscopic conventional suture-bridge technique resulted in comparable patient satisfaction, functional outcome, and rates of retear compared with the arthroscopic double-row technique in full-thickness rotator cuff tears.
Background: Suture bridge repair has been recognized to have superior biomechanical characteristics, as shown in previous biomechanical studies. However, it is not clear whether the tendon heals better in vivo after suture bridge repair.
Purpose: To evaluate the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique for patients with rotator cuff tears.
Study Design: Case series; Level of evidence, 4.
Methods: One hundred twenty-three shoulders (120 patients) that underwent arthroscopic suture bridge repair for full-thickness rotator cuff tear were enrolled for this study. The mean duration of follow-up was 25.2 months (range, 16-34 months). The postoperative repair integrity was analyzed with use of magnetic resonance imaging (MRI) in 87 shoulders. According to the retear patterns on postoperative MRI, the cases were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row).
Results: At the last follow-up, the University of California at Los Angeles (UCLA) score improved from the preoperative mean of 13.2 points to 29.7 points (P < .001). The rotator cuff was completely healed in 58 (66.7%) of the 87 shoulders, and there was a recurrent tear in 29 shoulders (33.3%). The incidence of retear tended to increase with age older than 60 years at the time of surgery (P = .002). When there was a larger intraoperative tear, the rate of retear was also higher (P = .002). When the severity of preoperative fatty degeneration of the cuff muscles was higher, there was a greater chance of a recurrent tear (P < .001). The retear patterns on postoperative MRI in 29 shoulders with recurrent failures were classified as type 1 in 12 shoulders (41.4%) and type 2 in 17 shoulders (58.6%). The preoperative cuff tear size did not have an influence on retear patterns (P = .236), but the percentage of type 1 retear increased with the severity of fatty degeneration or muscle atrophy (P = .041, .023).
Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the mean 25-month follow-up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient’s age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle. The retear in cases with a suture bridge technique tended to be more frequently at the musculotendinous junction.
