Arthroscopic double row cuff repair with suture-bridging and autologous conditioned plasma injection: Functional and structural results

Abstract

Purpose:The double row cuff repair with suture bridging is commonly used for arthroscopic rotator cuff repair (RCR). Despite its biomechanical qualities, the rate of iterative tears with this technique is important. The aim of our study was to evaluate the effect of autologous conditioned plasma (ACP) on functional results and on the rate of iterative tears after RCR by suture bridging.Materials and Methods:A consecutive series of 65 patients who underwent arthroscopic double-row suture bridge (Speed-Bridge, Arthrex) primary cuff repair of symptomatic full-thickness supraspinatus tear (retraction <3 in the Patte classification) were evaluated. Mean patient age was 60 (+/-8). The supraspinatus was repaired by knot-less bridging (SwiveLock, Arthrex) with suture tape material. 2 homogenous groups were created (A: 33 patients, B: 32 patients). In group A, all patients received, besides the cuff repair, an intra-tendinous ACP injection. Constant scores and Simple Shoulder Tests (SST) were measured pre-operatively and after a minimum follow-up period of 12 months post-operatively. Structural integrity of the repairs was evaluated by MRI according to the Sugaya classification. Sugaya >4 were considered as iterative tears.Results:Mean follow-up was 19 months (+/−42) in the 2 groups. The mean quantity of ACP injected was 6ml. (+/−1.5) and no specific complication of the injection was found. Mean preoperative Constant-Murley scores were 41,2 (±7,7) and 38 (±11)in group B. Mean normalized Constant-Murley score increased from 41 points (±7) pre-operatively to 70 points (±8) post-operatively in group A and from 38 points (±11) to 73 points (±11) in group B. There were no significative differences between the two groups (P > 0.05). In group A, 31 repairs were Sugaya 1-3 (94%), vs. 30 in group B (93%), and 1 was type 4 in group A (5%) vs. 2 in group B (8%).Conclusion:In both groups, RCR with suture bridging gave successful functional outcomes, with a low rate of iterative tear. In this preliminary study, the adjuvant effect of ACP injections could not be showed on both functional and structural results. Longer follow-up is needed to evaluate potential differences.

Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair

“…In 2007, Sugaya et al [41] introduced an MRI‐based classification system which gained wide acceptance for the evaluation of post‐operative rotator cuff integrity [2, 19, 20, 23, 25, 44] and correlated it with patient functional outcomes. Despite the proven sensitivity and specificity of US for the evaluation of post‐operative rotator cuff integrity [7, 14, 27, 32], there is no published US‐based classification system for this purpose.…”

Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics?

“…The most common activating reagent was calcium chloride (n = 5; 26.31%). 14 , 32 , 42 , 50 , 55 Other types of activators included thrombin (n = 4), 6 , 10 , 43 , 44 calcium gluconate (n = 3), 22 – 24 or a combination of thrombin and calcium chloride (n = 3) 29 – 31 ; 2 studies stated that no activator was required, 17 , 52 and 2 studies gave no information regarding PRP activation. 2 , 18 Of the 15 studies that used an activator for PRP, 14 gave the volume of the PRP activator (73.68%), d and 11 (57.9%) also gave the concentration of the activator.…”

“…Radiographic outcomes were recorded in 18 studies (94.7%). h Need for further surgery (n = 5; 26.3%), 14 , 17 , 31 , 43 , 55 and infection (n = 8; 42.1%), 17 , 22 , 30 , 31 , 42 , 50 , 52 , 55 were the least reported outcomes.…”

“…Relevant information regarding the study characteristics, including the study design, the level of evidence, mean follow-up time, and type of intervention was collected by 4 independent reviewers using a predetermined data sheet (M.G.D., H.A.L., A.M.F., V.T.O.). Four studies did not report level of evidence, 30 , 32 , 44 , 52 so it was determined based on the Oxford Centre for Evidenced-Based Medicine guidelines. 16 Adherence to the MIBO guidelines was recorded for each study.…”

Rotator Cuff Tears at the Musculotendinous Junction: Classification and Surgical Options for Repair and Reconstruction

“… 48 Similar findings have been reported by multiple studies. 13 , 17 , 49 , 50 Therefore, where possible, we prefer to perform bridging double-row repair for type A MTJ tears that occur either primarily or after previous double-row repair. When there is healthy muscle but a short, deficient medial tendon (type B MTJ tears) the repair can be augmented with a collagen graft.…”