A Modified Mason – Allen Suture Bridge for Musculotendinous Rotator Cuff Repair in Elderly Patient: A case report

Abstract

Introduction: As geriatric patient remains active, high functional outcomes is expected, treating rotator cuff in geriatric patient is usual nowadays. But, compromised vascularity and healing potential of soft tissue in older patients contributes to high incidence of re-rupture. Factor could be improved for decreasing the possibility of re-rupture is the suture technique. Modified Mason-Allen technique provides better biomechanical strength which offer high fixation strength, minimal gap formation and tendon strangulation and mechanical stability until tendon healing. Case Presentation: A 62-year-old female evaluated for 1 year history of pain around her right shoulder with history of trauma 1 year prior. From the physical examination, she reported significant decrease passive and active range of movement of the shoulder, particularly on abduction which less than 90 degrees. Neer test was positive with positive on Job test and Hawkins test. MRI showed a picture of massive rotator cuff tear. Corticosteroid injection and physical therapy were performed but pain and functional limitation still persisted. We decided to perform arthroscopy. We found subscapularis longitudinal tear, LHBT tear, humeral head bone defect, subacromial bursitis and massive supraspinatus tear. We perform acromioplasty, bursectomy, subacromial decompression, subscapular repair, debridement of supraspinatus footprint and anchor placement as modified Mason-Allen suture bridge. Clinical Discussion: In order to prevent re-tears, tendon fixation to bone and footprint reconstruction are important. Trans osseous-equivalent (suture bridge) was giving better biomechanical properties for the repaired tendon. In Modified Mason- Allen techniques, combination of horizontal matrass as a rip stops and vertical simple sutures as main holding power. This suture bridge was giving a compressive mechanism for enthesis to footprint enhancing healing. Several advantages of Mason – Allen suture bridge are very strong tissue holding property, rip stop which prevent tendon pull-out and less possibility strangulation, impingement or irritation. Conclusion: Modified Mason – Allen technique provides better biomechanical strength and restoration of footprint which allow the repaired tendon to heal and decrease the incidence of re-rupture.