Arthroscopic suture bridge transosseus equivalent fixation of rotator cuff tendon preserves intratendinous blood flow at the time of initial fixation

Christoforetti, John J.; Krupp, Ryan; Singleton, Steven B.; Kissenberth, Michael J.; Cook, Chad; Hawkins, Richard J.

doi:10.1016/j.jse.2011.02.012

Cited by 108 publications

(98 citation statements)

References 30 publications

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“…In a recent study, the blood flow at the repair site in 18 patients was measured by Doppler during standard medial knotted suture bridge fixation and the results showed a significant decline (44.6%) in the blood flow after placement of the second row of implants. [19] It is claimed that this decline in blood flow can compromise tendon healing. Furthermore, in the medial knotted technique, there may be a possibility of strangulation, which may worsen the blood flow and cause a relatively quick necrosis of the rotator cuff tendon at the medial row.…”

Section: Discussionmentioning

confidence: 99%

Comparison of early clinical results and re-tear rates of transosseous-equivalent rotator cuff repairs with or without medial knots

Gürpınar¹,

Polat

Tekin³

et al. 2019

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada, tam kat orta ile büyük boyutlu rotator manşet yırtığı olan hastalar için yaygın olarak kullanılan iki transosseöz eşdeğeri artroskopik rotator manşet onarımı tekniği olan düğümsüz ve medial düğümlü dikiş köprüsünün klinik sonuçları ve onarım bütünlüğü karşılaştırıldı. Hastalar ve yöntemler: Çalışmaya manşet yırtığı olan 121 hasta (55 erkek, 66 kadın; ort. yaş 56.7±7.3 yıl; dağılım, 39-72 yıl) dahil edildi. Toplamda 64 omuz konvansiyonel medial düğümlü dikiş köprüsü tekniği (grup A) ve 57 omuz düğümsüz dikiş köprüsü tekniği (grup B) kullanılarak ameliyat edildi. Constant skoru, görsel analog ölçeği (GAÖ) ve aktif öne fleksiyon açısı ameliyat öncesinde ve ameliyattan minimum 12 ay sonra değerlendirildi. Ameliyat sonrası rotator manşet bütünlüğü ortalama 19±4.7 ay sonra manyetik rezonans görüntüleme (MRG) ile değerlendirildi. Bulgular: Yaş, cinsiyet, vücut kitle indeksi değeri ve sagital MRG'de yırtığın ön-arka genişliği bakımından gruplar arasında anlamlı farklılık gözlenmedi. Ameliyat sonrası ortalama Constant skoru grup A'da 32.3±8.5 puandan 84±11.6 puana ve grup B'de 31.3±9.3 puandan 86.4±8.7 puana yükselirken (p<0.001) ortalama GAÖ skoru grup A'da 6.0±1.0'dan 1.3±1.2'ye, grup B'de 6.4±1.0'dan 1.0±0.8'e düştü (p<0.001). Kontrol MRG'lere göre, tekrar yırtık oranı grup A'da %10.9 (n=7) ve grup B'de %8.8 (n=5) idi. Gruplar arasında ne klinik skorlarda ne de tekrar yırtık oranlarında istatistiksel olarak anlamlı farklılık bulunmadı (p>0.05). Sonuç: Medial düğümlü tekniğe kıyasla daha az zaman alan ve daha basit olan düğümsüz teknik, ameliyattan en az bir yıl sonra benzer tatmin edici sonuçlar sağlar.Anahtar sözcükler: Çift sıra, düğümsüz dikiş köprüsü, medial düğümlü dikiş köprüsü, rotator manşet onarımı, transosseöz eşdeğeri onarım. ABSTRACTObjectives: This study aims to compare the clinical results and repair integrity of two of the commonly used transosseousequivalent arthroscopic rotator cuff repair techniques, which are the knotless and the medial knotted suture bridge, for patients with full-thickness medium to large-sized rotator cuff tears. Patients and methods:The study included 121 patients (55 males, 66 females; mean age 56.7±7.3 years; range, 39 to 72 years) with cuff tears. In total, 64 shoulders were operated on using the conventional medial knotted suture bridge technique (group A) and 57 shoulders were operated on using the knotless suture bridge technique (group B). The Constant score, visual analog scale (VAS) and active forward flexion angle were assessed preoperatively and after a minimum of 12 months postoperatively. Postoperative rotator cuff integrity was evaluated by magnetic resonance imaging (MRI) after a mean of 19±4.7 months. Results: There were no significant differences between the groups in terms of age, gender, body mass index, and anteroposterior extension of the tear on the sagittal MRIs. Postoperatively, the mean Constant score increased from 32.3±8.5 points to 84±11.6 points in group A and from 31.3±9.3 points to 86.4±8.7 points in group B (p<0.001), while th...

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Section: Discussionmentioning

confidence: 99%

Comparison of early clinical results and re-tear rates of transosseous-equivalent rotator cuff repairs with or without medial knots

Gürpınar¹,

Polat

Tekin³

et al. 2019

Eklem Hastalik Cerrahisi

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“…The gold standard of transosseous fixation of the rotator cuff to the tuberosity as described in open techniques has yet to be consistently met with arthroscopic techniques. Christoforetti et al 9 discussed the issue of intratendinous blood flow after arthroscopic suture bridge transosseous equivalent fixation of the rotator cuff. 4,5 As a result, newer arthroscopic techniques, such as double row fixation and transosseous equivalent techniques, were developed in an attempt to reproduce the secure transosseous fixation often performed in open rotator cuff repair surgery.…”

Section: Current Challenges In Rotator Cuff Repairmentioning

confidence: 99%

Open rotator cuff repair

Carroll¹

2013

Current Orthopaedic Practice

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Recent studies and advances in the treatment of rotator cuff tears have focused on factors that may or may not influence healing of the rotator cuff with surgical treatment. These advances include the use of sophisticated arthroscopic repair techniques and biologics in the setting of surgical rotator cuff repair. Additional studies have examined the role of postoperative physical therapy in relationship to rotator cuff healing and clinical improvements after rotator cuff surgery. Although many of the current studies include surgical treatment of the rotator cuff with arthroscopic techniques, all of the advances can be applied in the setting of open and mini-open repair techniques. Despite the current enthusiasm for arthroscopic rotator cuff surgery, there is no compelling data to suggest that clinical outcomes of arthroscopic rotator cuff repair, in general, are significantly improved over open repair techniques. Moreover, it has been well documented that arthroscopic repairs are more costly and more time consuming than mini-open techniques. Nonetheless, recent trends have documented a gradual progression away from open rotator cuff repair in favor of arthroscopic rotator cuff repair.

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“…Bei den neueren Bridging-Techniken kommt es, insbesondere durch Verstärkung der medialen Reihe durch zusätzliche Sehnenperforationen mit oder ohne Knoten, zu einer zusätzlichen Steigerung der Primär-stabilität [1,14]. Als Preis für diese erhöh-te mechanische Stabilität sind die zusätzli-chen Sehnenperforationen, die Erhöhung des Nahtmaterialvolumens in und auf der geschädigten Sehne und der dazugehöri-ge Gewebestress zu nennen [6,15]. Christoforetti et al konnten in einer intraoperativen Fallserie mit 18 konsekutiven Patienten mittels Laser-Doppler-Sonde eine signifikante Reduktion des intratendinö-sen Blutflusses von 44,7% nach Setzen der lateralen Reihe der Suturebridge (medial 4 Sehnenperforationen mit 2 Knoten) nachweisen [6].…”

Section: Nahttechnikenunclassified

“…Als Preis für diese erhöh-te mechanische Stabilität sind die zusätzli-chen Sehnenperforationen, die Erhöhung des Nahtmaterialvolumens in und auf der geschädigten Sehne und der dazugehöri-ge Gewebestress zu nennen [6,15]. Christoforetti et al konnten in einer intraoperativen Fallserie mit 18 konsekutiven Patienten mittels Laser-Doppler-Sonde eine signifikante Reduktion des intratendinö-sen Blutflusses von 44,7% nach Setzen der lateralen Reihe der Suturebridge (medial 4 Sehnenperforationen mit 2 Knoten) nachweisen [6]. Inwieweit diese Folge der Gewebeperforierung und -strangulierung zu einer Kompromittierung der Biologie der Sehne mit der möglichen Folge eines verminderten Heilungspotenzials führt, ist noch weitestgehend unbekannt.…”

Section: Nahttechnikenunclassified

Möglichkeiten der Speedbridge-Technik

et al. 2012

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Für die erfolgreiche operative Versorgung von Rotatorenmanschetten(RM)-Läsionen ist die richtige Balance zwischen ausreichend starker Primärfixation und Schonung der Biologie der Sehne wesentlich. Insbesondere bei der Heilung der Sehne kann die vollständig knotenlose und flächige Refixierung des gerissenen Sehnenmaterials mittels Speedbridge-Technik von Vorteil sein. Neben der ursprünglichen knotenlos gekreuzten Doppelreihenkonfiguration mit 4 Ankern kann diese, je nach Defektgröße und -form, auch in einer knotenlosen V-, W(Kassiopeia)-oder auch in einer VW-Konfiguration eingesetzt werden.

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Arthroscopic suture bridge transosseus equivalent fixation of rotator cuff tendon preserves intratendinous blood flow at the time of initial fixation

Cited by 108 publications

References 30 publications

Comparison of early clinical results and re-tear rates of transosseous-equivalent rotator cuff repairs with or without medial knots

Comparison of early clinical results and re-tear rates of transosseous-equivalent rotator cuff repairs with or without medial knots

Open rotator cuff repair

Möglichkeiten der Speedbridge-Technik

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