Knot impingement after arthroscopic rotator cuff repair mimicking infection: A case report

Abstract

BACKGROUND Knot impingement as a complication after arthroscopic rotator cuff repair (ARCR) has been suggested as a cause of persistent pain with limited motion. We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion, which was confused with infection. CASE SUMMARY A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room. Passive range of motion could not be evaluated due to the patient’s severe pain. The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder. An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder, and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging. Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils. The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed. Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials. The patient’s symptoms subsided immediately after the surgical procedure. CONCLUSION Although the incidence of knot impingement is rare, the possibility of knot impingement after ARCR should be a consideration.

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

“…[58]. Durch die Wiederaufnahme der medial durchgestochenen Fäden/ Tapes mit Abspannen nach lateral legen sich diese glatt auf den Sehnenstumpf, so dass ein subakromiales Knoten-Impingement vermieden werden kann [36].…”

Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis

“…The conventional suture bridge techniques involved medial knots in the medial row of the tendon to provide increased repair strength and less gap development [ 1 , 2 ]. However, the medial knots may cause strangulation of the repaired tendon and eventually hamper the healing process and raise the chance of type 2 re-tears [ 3 – 5 ]. To avoid these risks, the knotless suture bridge techniques were implemented, in which the sutures were attached to medial anchors, passed through the tendon without knots, then secured with lateral knotless anchors [ 6 , 7 ].…”