A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

Abstract

Background: Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs). Purpose: To compare clinical outcomes and tendon integrity between knotless layer–by–layer and conventional en masse repair techniques for delaminated RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer–by–layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI. Results: Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow–up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; P = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; P = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 ( P = .046). Conclusion: En masse repair using the suture bridge technique and the knotless layer–by–layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer–by–layer technique.

Outcomes After Double-Layer Repair Versus En Masse Repair for Delaminated Rotator Cuff Injury: A Systematic Review and Meta-analysis

“…Among the 11 studies, we removed 5, as 1 study 33 was written in Chinese, 1 study 29 included partial rotator cuff tears, 2 studies 12,18 restored only the bursal layer, and 1 study 3 included nondelaminated rotator cuff tears. In the end, 1 RCT 21 and 5 observational studies 11,15,16,28,30 were included in this meta-analysis. Figure 1 presents the flowchart for the study-inclusion process.…”

“…Some have reported that the DL technique can have a better clinical outcome, and others have reported that both techniques have equivalent outcomes. 4,16…”

Outcomes After Combined Remnant Preservation and Bone Marrow Stimulation for Acute Rotator Cuff Tears

“…One of the main goals of rotator cuff repair surgery is to relieve pain and restore shoulder function. A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. At the final follow-up, the VAS, Constant, ASES, and UCLA scores were 1.1 ± 0.9, 84.3 ± 16.4, 88.3 ± 17.4, and 31.1 ± 6.0, respectively.…”

“…Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction, and arthroscopic repair is an effective treatment for rotator cuff tears. 9 , 19 There are many surgical methods for rotator cuff repair, including single-row or double-row anchor repair technology, layer-by-layer suture bridge technology, transosseous tunnel technology, and patch augmentation technology. The objective of these methods is to reattach the torn tendon to its footprint and fix it to create favorable conditions for tendon-bone healing at the native enthesis of the rotator cuff.…”

Delamination of rotator cuff tears impairs healing after repair: a systematic review and meta‐analysis

“…The other method is a layered suture under arthroscopy, which adheres to the original anatomical structure of the rotator cuff by separately fixing the synovial sac of the rotator cuff and the lateral aspect of the joint. No significant difference was observed between separate and en bloc repairs [11, 12], it is unclear if tendon delamination affects rotator cuff repair healing and clinical outcomes. Delamination is a risk factor for poor clinical and anatomical outcomes after rotator cuff repair [2, 13, 14].…”