Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Kuroda, Shigehito; Ishige, Noriyuki; Mikasa, Motohiko

doi:10.1007/s11999-013-3148-7

Cited by 62 publications

(103 citation statements)

References 18 publications

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“…Creating these small-diameter footprint tunnels maximizes the tendon-footprint contact area, and subsequently, the bone-tendon healing area is substantially increased as compared with traditional larger anchors. This technique is ideally suited to revision cases in which previous anchor pullout has occurred or in which traditional anchors have been placed very close to one another 8,11,12 (Fig 6). Our technique involves drilling a transosseous tunnel to the axillary pouch using an ACL guide to ensure accurate and safe drill placement.…”

Section: Discussionmentioning

confidence: 99%

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation

Aramberri-Gutiérrez¹,

Martínez-Menduiña²,

Valencia-Mora³

et al. 2015

Arthroscopy Techniques

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Abstract:We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The proximal end of the guide is approximated to the greater tuberosity at the cuff footprint, and a complete transosseous tunnel is created with a 2.4-mm drill. An all-suture implant is inserted through this tunnel down to the calcar, and its deployment is visualized under arthroscopy. Gentle traction is applied to the anchor, resulting in a 4-mm concertina of the suture anchor that rests opposed to the medial cortex. The major advantage of this technique is the fixation strength gained from the biomechanically superior cortical bone of the calcar. Furthermore, this method permits greater preservation of bone surface area at the level of the footprint for a larger tendon-to-bone healing surface. This technique also provides an excellent alternative in revision situations. R otator cuff pathology is a common problem, with an incidence of 87 per 100,000 person-years. The highest incidence of this pathology is seen in women and in the age group 55 to 59 years.

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Section: Discussionmentioning

confidence: 99%

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation

Aramberri-Gutiérrez¹,

Martínez-Menduiña²,

Valencia-Mora³

et al. 2015

Arthroscopy Techniques

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“…We read the article by Kuroda et al [3] with great interest. In the current study, the authors describe a novel arthroscopic transosseous technique without the use of anchors.…”

Section: To the Editormentioning

confidence: 99%

“…Kuroda et al [3] reported that the technique cannot be used in shoulders where the stump of the torn rotator cuff does not emerge across the top of the humeral head under traction. Also, operative time is rather long, ranging from 80 minutes to 176 minutes.…”

Section: To the Editormentioning

confidence: 99%

Letter to the Editor: Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Bićanić

Čičak²,

Tršek³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The overall average operating time for our procedure is approximately 105 minutes in 384 cases [4]. In order for a procedure using anchors to be less expensive, it would have to be 99 minutes shorter than that, or about 6 minutes in length (105 minutes -99 minutes = 6 minutes), which seems quite unrealistic.…”

Section: To the Editormentioning

confidence: 99%

Reply to the Letter to the Editor: Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Kuroda

Ishige

Mikasa

2014

Clinical Orthopaedics &Amp; Related Research

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To the editor,We appreciate the valuable comments of Bicanic and colleagues, which describe previously reported transosseous suture methods, limitations, costs, possible pullout of the sutures, and complexities of the suturing in the procedure we reported.The hybrid technique of anchor and transosseous sutures reported by Cicak et al. [2], and the transosseous suture technique using a hollow needle reported by Matis et al.[5], differ from our technique. We make a long straight bone tunnel from the lower margin of the greater tuberosity to the footprint. With our procedure, large tears where the stump of the torn rotator cuff does not emerge across the top of the humeral head under traction can be repaired by expanding decortication of the footprint to the inner side. However, there is a high retear rate.The extra cost of prolonged operation time is generally attributable to personnel expenses. Our technique requires two surgeons, one anesthesiologist, and three nurses. In our hospital, doctors and nurses are paid ¥ 12,500/hour and ¥ 3200/hour, respectively. Therefore, the total personnel costs are ¥ 47,100/hour (¥ 12,500 9 3 + ¥ 3200 9 3). The anchor method uses an average of 2.3 anchors [3]. These cost ¥34,300 each in Japan. The total cost of the anchors is ¥ 78,890 (¥ 34,300 9 2.3 anchors). The polyester threads used in our procedure cost ¥840. Therefore, the anchors cost ¥ 78,050 more (¥ 78,890 À ¥ 840) than the polyester threads. This is equivalent to personnel expenses for 99 minutes (¥ 78,050 7 ¥ 47,100 9 60).The anchor method is cheaper only if the procedure is 99 minutes shorter than our approach. The overall average operating time for our procedure is approximately 105 minutes in 384 cases [4]. In order for a procedure using anchors to be less expensive, it would have to be 99 minutes shorter than that, or about 6 minutes in length (105 minutes -99 minutes = 6 minutes), which seems quite unrealistic.In our procedure, knot tying is performed at the lower margin of the greater tuberosity where the bone cortex is solid. Additionally, the knots are not sliding, but static. Therefore, no rupture of sutures due to friction in the bone tunnel occurred in our cases. Breakage of (or pullout from) the bone tunnel occurred only in one osteoporotic patient (0.3%). In comparison, the frequency of anchor pullout is reportedly 2.4% [1]. Our procedure is more suitable for osteoporotic patients.

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Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Cited by 62 publications

References 18 publications

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation

All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation

Letter to the Editor: Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Reply to the Letter to the Editor: Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

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