Double-row rotator cuff repairs lead to more intensive pain during the early postoperative period but have a lower risk of residual pain than single-row repairs

Abstract

Purpose The purpose of this study is to compare pain patterns and identify factors associated with residual shoulder pain after rotator cuf repairs using double-row and single-row techniques. Methods A cohort study was performed using patients who underwent arthroscopic rotator cuf repairs at our center in 2015. Patients were allocated according to the repair technique into an single-row (SR) group or a double-row (DR) group. Visual Analog Scale (VAS) scores for pain were assessed at 1 week, 3 months, 6 months, 12 months and 24 months after surgery. Functional and radiographic assessments were performed at least 24 months postoperatively. The proportion of patients with residual pain and factors associated with residual shoulder pain (VAS > 0 at the inal follow-up) were analyzed in both groups. Results Fifty-two patients were enrolled in the SR group, and 53 were enrolled in the DR group. The DR group appeared to have higher levels of pain 1 week (P < 0.001) and 3 months (P = 0.041) postoperatively, while at other time points, the pain intensity of the two groups was comparable. Fourteen (26.4%) and 25 (48.1%) patients in the DR and the SR groups, respectively, developed residual shoulder pain, (P = 0.022; RR 1.82). The univariate analysis and multiple regression revealed that a poorer quality of tendon tissue is related to residual pain in the SR group, whereas tendon retraction is associated with residual pain in the DR group. The rate of re-tear was similar between the two groups and between patients with and without residual pain. Conclusions The DR repair technique results in a greater intensity of pain than that of SR repair during the irst 3 months after surgery; however, patients who underwent DR repair presented a signiicantly lower proportion of residual shoulder pain and better tendon quality after 2 years. Poorer tendon quality and larger tendon retraction as determined intraoperatively were risk factors for residual pain. These results highlight the necessity of promoting healing on the grounds of residual pain prevention. Level of evidence II.

Tendon Healing Progression Evaluated With Magnetic Resonance Imaging Signal Intensity and Its Correlation With Clinical Outcomes Within 1 Year After Rotator Cuff Repair With the Suture-Bridge Technique

“…The progression of clinical outcomes has been widely studied. 5,41,45,52 It seems that most improvements in clinical outcome after RCR occur within 6 months after surgery. Fealy et al 13 found that the mean UCLA, L’Insalata, and ASES scores were significantly improved at 6 months postoperative.…”

“…Postoperative secondary adhesive capsulitis has been thought to be the major reason for pain and dysfunction. 5,15 We further compared the SNQd, SNQp, and ER 0 (an important physical sign of adhesive capsulitis 51 ) in the VAS >3 group to those in the VAS ≤3 group. No significant difference was seen in SNQd or ER 0 , while the SNQp value of the VAS >3 group was significantly higher than the VAS ≤3 group at 1 and 3 months.…”

“…24,36 The musculotendinous changes during the recovery process, such as inflammation, tendinitis, or preexisting tendinosis, might be related to pain, dysfunction, and potential failure of healing after RCR. 5,20,32,54 Magnetic resonance imaging (MRI) is widely used for evaluating tendon structural integrity and musculotendinous changes. Signal intensity (SI) on MRI is thought to reflect the healing of the repaired tendons.…”

Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study

“…In the majority of current rehabilitation protocols, unlimited return to activity and daily labor are permitted typically at 6 months. 9,29 While limited by small numbers and the absence of histopathological findings for the repaired tendons, these data suggest that it may be meaningful to monitor the quantitative MRI measurements of the repaired tendon before making a progressive rehabilitation strategy at 6month follow-up.…”

The Arthroscopic “Montgolfier Double-Row Knotless” Rotator Cuff Repair Technique

“…Similarly to other knotless suture anchor repairs, 1 limitation is that failure of the medial- or lateral-row anchor(s) will cause failure of the entire construct. In addition, recent evidence has shown that double-row repairs are associated with higher visual analog scale scores during the first 3 months after surgery compared with single-row repairs 20 . From a biomechanical standpoint, there has not been a study to validate this technique and compare it with other existing double-row suture anchor repairs.…”