Clinical outcomes and repair integrity of arthroscopic rotator cuff repair using suture-bridge technique with or without medial tying: prospective comparative study

Kyung Cheon Kim, Hyun Dae Shin, Woo-Yong Lee, Kyu-Woong Yeon, Sun-Cheol Han, Kyung Cheon Kim, Hyun Dae Shin, Woo-Yong Lee, Kyu-Woong Yeon, Sun-Cheol Han

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.

Keywords: Knotless; Medial knot tying; Rotator cuff; Suture-bridge.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Chungnam National University Hospital, and the requirement for informed consent was waived. This study was conducted in accordance with the latest version of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Arthroscopic view showing a rotator cuff tear involving the supraspinatus. b The arthroscopic view from the lateral portal shows complete repair of an rotator cuff tear using the knotless suture-bridge technique without medial tying (*)
Fig. 2
Fig. 2
a Arthroscopic view showing a rotator cuff tear involving the supraspinatus. b The arthroscopic view from the lateral portal shows complete repair of a rotator cuff tear using the conventional suture-bridge technique with medial tying (*)
Fig. 3
Fig. 3
Follow-up T2-weighted sagittal magnetic resonance imaging at 6 months post-operation shows an unhealed tendon of a repaired rotator cuff (type I re-tear). a Conventional suture-bridge technique. b Knotless suture-bridge technique
Fig. 4
Fig. 4
Follow-up T2-weighted magnetic resonance imaging at 6 months post-operation shows medially ruptured tendons and a healed footprint of a repaired rotator cuff (type II re-tear). a Conventional suture-bridge technique. b Knotless suture-bridge technique

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