A technique for repairing rotator cuff transtendinous tears with a remnant attached to the footprint

Abstract

Background Some unusual rotator cuff (RC) tears are located in more proximal tendinous portions, with substantial remnant tissue attached to the footprint. The two options for surgical repair are sacrificing or preserving the remnant tissue. We introduce a surgical repair technique that preserves as much of the remnant footprint as possible. Surgical technique A double-loaded suture anchor is inserted into the subchondral bone at the medial portion of the RC footprint; the lateral remnant tissue is preserved. Each strand is shuttled and repassed through the medial portion of the tendon in a mattress fashion using a suture hook device. Then, multiple no. 1 PDS sutures are passed through the medial and lateral stumps and left untied. Strands from the suture anchor are first tied in a double mattress fashion. Then, the repair is completed by tying the remaining no. 1 PDS sutures. Conclusions We propose a remnant-preserving RC repair technique for transtendinous RC tears with sufficient tissue remaining within the RC footprint. This technique appears advantageous in terms of re-establishing an environment that promotes tendon healing after repair.

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

“…In contrast, several studies found that the native enthesis was well preserved in 75% of acute rotator cuff tear cases. 3 , 26 , 33 Therefore, we believe that the RP-BMS technique may be more appropriate for the repair of acute rotator cuff tears than the conventional repair technique. This technique may improve tendon integrity of repair by preserving the remnant tissue of the torn tendon in acute rotator cuff tear.…”

“… 5 , 8 , 31 Therefore, we have reason to believe that a modified surgical technique that utilizes the native enthesis of the rotator cuff by preserving the rotator cuff remnant tissue may stimulate the inherent healing potential of the rotator cuff tendon-bone interface. 3 , 28 …”

“…9,37 After acute rotator cuff tears, there is often a large amount of rotator cuff remnant tissue attached to the footprint area of the humeral tubercle, and native enthesis is usually preserved well. 3,33 A study found that these remnant tissues were rich in tendon-derived stem cells and new blood vessels, which may facilitate healing after rotator cuff repair. 16 Furthermore, several studies have demonstrated that there are a large number of mechanoreceptors at the rotator cuff tendon-bone junction, and retaining the remnant tissue of the rotator cuff may promote the recovery of proprioception after surgery.…”

“…5,8,31 Therefore, we have reason to believe that a modified surgical technique that utilizes the native enthesis of the rotator cuff by preserving the rotator cuff remnant tissue may stimulate the inherent healing potential of the rotator cuff tendon-bone interface. 3,28 Biological techniques to promote rotator cuff healing have also attracted extensive attention in recent years. Mesenchymal stem cells (MSCs), slow-release growth factors, and biological patches are increasingly used to improve the biological healing process of rotator cuff repair.…”

NAMPT-Improved Mitochondrial Function Alleviates Degenerative Rotator Cuff Tendinopathy in Aged Mice

“…The effects of aging on the rotator cuff have previously been studied mainly at the tendon-to-bone interface 34,35 . However, most tears are found in tendon tissues that are proximal to the enthesis, instead of at the enthesis itself 28 . The histological analysis in the present study revealed that tendon tissues proximal to the enthesis site exhibited more severe degenerative changes.…”