Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears
“…Single-and double-row techniques have been described. 11,12 Ide et al 12 found a retear rate of nearly 35% using a single-row technique, higher than what was found by the authors of the present study. 5 Double-row fixation has become more recently popular, 11 with an emphasis on repairing the native anatomy.…”
Section: See Related Article On Page 1973contrasting
confidence: 62%
“…11,12 Ide et al 12 found a retear rate of nearly 35% using a single-row technique, higher than what was found by the authors of the present study. 5 Double-row fixation has become more recently popular, 11 with an emphasis on repairing the native anatomy. 13 Yoo et al's 13 important work highlighted the subscapularis footprint as well as the "leading edge," which is thought to be the initial tear site of the tendon.…”
Section: See Related Article On Page 1973contrasting
Retraction and scarring of subscapularis tears make arthroscopic fixation technically challenging. The ideal arthroscopic technique is still under debate, with new studies examining the importance of repairing the "leading edge." Regardless of single-or double-row fixation, it is our opinion that restoring the native anatomy as well as any concomitant biceps pathology is essential for postoperative success.
“…Single-and double-row techniques have been described. 11,12 Ide et al 12 found a retear rate of nearly 35% using a single-row technique, higher than what was found by the authors of the present study. 5 Double-row fixation has become more recently popular, 11 with an emphasis on repairing the native anatomy.…”
Section: See Related Article On Page 1973contrasting
confidence: 62%
“…11,12 Ide et al 12 found a retear rate of nearly 35% using a single-row technique, higher than what was found by the authors of the present study. 5 Double-row fixation has become more recently popular, 11 with an emphasis on repairing the native anatomy. 13 Yoo et al's 13 important work highlighted the subscapularis footprint as well as the "leading edge," which is thought to be the initial tear site of the tendon.…”
Section: See Related Article On Page 1973contrasting
Retraction and scarring of subscapularis tears make arthroscopic fixation technically challenging. The ideal arthroscopic technique is still under debate, with new studies examining the importance of repairing the "leading edge." Regardless of single-or double-row fixation, it is our opinion that restoring the native anatomy as well as any concomitant biceps pathology is essential for postoperative success.
“…Regarding the conventional suture bridge technique, the medial row knot was tied by using horizontal mattress configuration [1]. Busfield et al [3] confirmed the importance of the medial knots in protecting the repair site from biomechanical stresses because of increase in gapping at the repair site and decrease in load transmission.…”
Section: Discussionmentioning
confidence: 99%
“…Suture bridge technique has been widely accepted in rotator cuff repair because of its better biomechanical properties and satisfactory clinical outcomes [1]. More commonly in the fixation configuration, the suture bridge involves tying knots in medial row.…”
Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6 ± 78.0 N, P = 0.04 for KSB group; P < 0.001 for USB group), stiffness (58.0 ± 10.7 N/mm, P = 0.005 for KSB group; P < 0.001 for USB group), and lowest elongation (1.49 ± 0.39 mm, P = 0.009 for KSB group; P = 0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5 ± 65.0 N) than USB repair (363.5 ± 52.3 N, P = 0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P = 0.396 for stiffness and P = 0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.
“…The extent of internal rotation was assessed at the height of the thoracic spinous process reached by a thumb. In accordance with the Ide et al proposal, the first to fifth lumbar vertebrae were described as 13 to 17, the sacrum as 18, and the buttocks as 19 [ 6 ]. Fig.…”
BackgroundThe suture-bridge (SB) method has recently become the mainstream means of repairing full-thickness rotator cuff tears. However, in some patients the deep and superficial layers have moved in different directions because of delamination of their rotator cuffs. In such cases, a simple suture (double-layer, double-row [DD] method) is used to repair the superficial and deep layers separately. The purpose of this study was to analyze the clinical outcomes and re-tear rates of the DD and SB methods, with patients selected according to the condition of their torn cuffs.MethodsWe retrospectively registered 74 patients with full-thickness rotator cuff tears that had been repaired arthroscopically, 35 shoulders by the DD and 39 by the SB method. Mean ages were 66.1 years in the DD and 62.9 years in the SB group. We evaluated clinical status before and after surgery (Japanese Orthopedic Association [JOA] scores) and re-tear rate. The Wilcoxon signed-ranks test was used to compare JOA scores and active ROM between before and after surgery in each group. Mann–Whitney’s U test was used for comparing JOA scores, active ROM, re-tear rates, size of tear, duration of follow-up, sex, and presence of subscapular muscle repair between the DD and SB groups. A hazard ratio of less than 5% was considered to denote significance.ResultsJOA scores improved significantly in the DD and SB groups from preoperative means of 63.4 and 63.3 points, respectively, to postoperative means of 91.8 and 92.1 points, respectively. The active flexural ROM improved significantly from means of 110.1° and 100.0°, respectively, to postoperative means of 142.3° and 142.7°, respectively; the differences between groups were not significant. Re-tear occurred in 5.9% of the DD (two of 34 shoulders) and 7.9% of the SB group (three of 38 shoulders); its incidence did not differ significantly between the two groups.ConclusionsBoth the DD and SB methods achieve satisfactory clinical outcomes that do not differ significantly. Our results suggest that careful selection of operative method on the basis of the delamination pattern in patients undergoing RCT may reduce the re-tear rate after utilizing the SB method.
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