Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears

Abstract

PurposeThe purpose was to evaluate the clinical and radiological results of knotless repair with flat‐braided suture in full small‐sized supraspinatus tendon tears (< 1 cm). MethodsA consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat‐braided suture (2 mm wide). Minimal follow‐up required was 5 years. Changes in Murley–Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate. ResultsFifty‐four patients were included. Mean age was 57 ± 4 years. The average follow‐up was 68 ± 10 months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow‐up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow‐up (p < 0.001). The strength score was significantly higher post‐operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1–2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair. ConclusionThe use of a knotless arthroscopic construct with flat‐braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization. Level of evidenceLevel III.

Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair

“…Predicting a retear before surgery may help surgeons and patients select the optimal treatment. Regarding the retear rate, many previous studies have reported retear rates ranging from 5 to 57% [1, 6, 7, 9, 12, 13, 16, 20, 22–24, 26, 31, 32, 34, 36, 38, 40, 43–47, 49], and retear can lead to the deterioration of the clinical outcome. The retear rate depends on the size of the rotator cuff tear [2, 4, 5, 8, 10, 11, 14, 21, 29, 33, 35, 37, 38, 41, 42].…”

“…The retear of a repaired tendon is one of the most severe complications after arthroscopic rotator cuff repair (ARCR). The rate of retear has been reported to be 5–57% [1, 6, 7, 9, 12, 13, 16, 20, 22–24, 26, 31, 32, 34, 36, 38, 40, 43–47, 49], and some previous studies reported that the postoperative clinical outcomes in patients with retears after ARCR were significantly inferior to those in patients who healed [3, 34, 47].…”