Arthroscopic Transosseous Suture Without Implant for Rotator Cuff Tears: Absorbable Mattress Sutures Versus Non-Absorbable Sutures

Abstract

AIM: In 2005, we developed an anchorless technique for arthroscopic transosseous rotator cuff repair without implant. We aimed to clarify the differences in clinical outcomes and retear rates between patients receiving absorbable mattress sutures and those receiving non-absorbable sutures. MATERIALS AND METHODS: In this retrospective cohort study, we analyzed 131 cases in which absorbable mattress sutures were used and 384 cases in which only non-absorbable sutures were used. Three 2-mm Kirshner wires with perforated tips were inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint. After pulling the rotator cuff stump laterally, 3 Kirshner wires were threaded through the rotator cuff and skin. Five threads were passed through 3 bone tunnels using the perforated tips of the Kirshner wires. The surgery was completed by inserting 2 mattress sutures and 3 bridging sutures. In addition to retear rates, the surgical cost of other transosseous methods was investigated. RESULTS: The retear rate was 3.1% using absorbable mattress sutures and 6% using non-absorbable suture only. It was 12% using the hollow needle method and 3.7% using the ArthroTunneler method. The surgical cost was $9-12 for our procedure, $121 for the hollow needle method, and $600 for the ArthroTunneler method. CONCLUSIONS: We found that using absorbable thread for mattress sutures reduced the retear rate. A big advantage of our technique is that it is inexpensive because the only surgical materials required are suture threads.

Clinical and Economic Advantages of Anchorless Arthroscopic Transosseous Suture Repair of the Rotator Cuff

“…1 Since May 2015, we have been using polyglycolic acid (PGA) sutures in mattress suturing to obtain satisfactory initial fixing power without applying excessive tension on the rotator cuff. 2 This study validated the clinical outcomes of ATOS using absorbable mattress sutures and its advantages in terms of cost.…”

“…21 Moreover, few reports have revealed the clinical outcomes of this technique in more than 50 patients. 1,2,13,14,16 That is, the retear rates were 12% in the study of Matis's report, 14 which used a hollow needle, and 3.7% in the report of Flanagin, 13 which used the ArthroTunneler™.…”

“…The angle is commonly 60º-65º. 2 Thus, an insertion angle of 60° is suitable for any case. Postoperative MRI showed that the neurovascular bundle and Kirschner wire insertion point are distant from each other (Figure 15).…”