Does the Dog-Ear or Bird-Beak Deformity Remodel After Rotator Cuff Repair?

Abstract

Background: Dog-ear and bird-beak deformities are common after transosseous-equivalent repair (suture bridge technique). The natural course of deformities after rotator cuff (RC) repair using the suture bridge technique is unclear. The remodeling potential of these deformities has not been investigated. Purpose: To evaluate remodeling and retear rates associated with deformities after RC repair. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2011 and February 2012, we studied 99 consecutive shoulders. All patients underwent arthroscopic RC repair via the suture bridge technique with or without additional sutures. Two groups were formed: no deformity (n= 46) and deformity (n = 53). Deformity was defined as marginal detachment and protrusion of the RC after repair, involving inappropriate compression of the suture limbs from the anchors. Tendon height was measured from the highest point of the most protruding portion of the cuff to the cortex on semi-coronal magnetic resonance imaging (MRI) scan. Change in tendon height was evaluated on MRI scan at 1 week and 6 months postoperatively. Clinical assessment at every patient visit included the American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and visual analog scale for pain (pVAS) score. Results: No significant differences were found in age, sex, symptom duration, tear size, and preoperative ASES, Constant, and pVAS scores ( P > .05) between the 2 groups. The initial tendon height was 7.4 ± 1.5 mm in the no-deformity group and 9.3 ± 2.0 mm in the deformity group. Follow-up height was 6.3 ± 2.1 mm in the no-deformity group and 6.4 ± 1.6 mm in the deformity group. Mean postoperative tendon heights were 90.1% ± 23.8% of the initial height in the no-deformity group and 73.2% ± 15.1% in the deformity group. Clinical scores (ASES, Constant, and pVAS) were not significantly different between the groups at 6 months. There were 4 shoulders in each group that experienced retearing (types 4 and 5 according to the Sugaya classification) at 6 months postoperatively. There was no difference in retear rate ( P > .999). Conclusion: Most deformities after RC repair were remodeled with no effect on retears. Clinical outcomes were not affected by deformities.

Magnetic Resonance Imaging Evaluation of Tendon Integrity Initially After Arthroscopic Rotator Cuff Repair: Single Row Versus Suture Bridge Technique

“…In cases with normal tendons, the re-tear sign on the rotator cuff tendon on MRI may be due to con guration deformities ((such as dog-ear deformity). Speci cally, most deformities after rotator cuff repair were remodeled and rotator cuff tendon coverage may improve with time [14,28]. Previously, Jin et al [29] found that three patients who were classi ed as Sugaya type III at three months after surgery appeared as Sygaya type II at one year postoperatively.…”