Paper 180: Retear Patterns After Arthroscopic Rotator Cuff Repair: Single Row Repair Technique vs. Suture Bridge Technique

Cho, Nam Su; Yi, Jin Woong; Cho, Seung-Hyun; Rhee, Yong-Girl

doi:10.1016/j.arthro.2012.05.663

Cited by 79 publications

(161 citation statements)

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“…2,3) The suture bridge technique tended to better preserve the cuff tissue repaired at the insertion site of the rotator cuff and give more mechanical strength than the single-row technique. 4) In a systematic review by Hein et al, 1) the rate of retear was lower in the methods of rotator cuff repair using medial row fixation, including double-row technique and suture-bridge technique, than the method using the single-row technique.…”

Section: Discussionmentioning

confidence: 99%

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New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Choi¹,

Kim²,

Nam³

2016

Clinics in Shoulder and Elbow

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Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope. While successful outcomes of patients treated by arthroscopic rotator cuff repair have been reported by virtue of recent advances in arthroscopic techniques and their instrumentation, overall rates of retear from 21% to 26% were reported in patients after rotator cuff repair according to the repair technique. 1)Retear patterns after arthroscopic rotator cuff repair can be classified into two patterns according to the retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method.2) This classification is widely used to differentiate retear type after rotator cuff repair. These retear patterns might be caused by a mismatch on the tension applied on the tendon. However, not all retears of the rotator cuff were applicable to this classification.3) Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging (MRI) in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope. Case ReportCase 1A 60-year-old female patient presented continuous pain in the right shoulder for 2 months. In her previous history, she had undergone rotator cuff repair of the right shoulder for a mediumsized suprasupinatus tear (2×2 cm size, crescent type) by the arthroscopic suture bridge technique 3 years ago in this clinic. Two medial suture anchors and two lateral suture anchors were used for the arthroscopic suture bridge technique. Torn cuff tendon was repaired with slightly anteriorly weighted tension to restore the foot print without excessive tension. The patient showed improved symptoms after the operation. She repeatedly practiced yoga beyond the normal range of motion of the shoulder with a yoga trainer. Without any special traumatic event, symptoms gradually worsened. Routine serial ultrasonography revealed that the repaired cuff maintained normal thickness until 1 year

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Section: Discussionmentioning

confidence: 99%

“…Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. 2) This classification is widely used to differentiate retear type after rotator cuff repair. These retear patterns might be caused by a mismatch on the tension applied on the tendon.…”

mentioning

confidence: 99%

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Choi¹,

Kim²,

Nam³

2016

Clinics in Shoulder and Elbow

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“…7) However, there is an increasing concern that strangulation of the medial tendinous portion can be elicited by multiple medial knot-tying, resulting in subsequent deterioration of tendon viability. 4,5) Strangulation was speculated as one of the causes of medial cuff failure, which is a more frequentlyencountered condition in double row technique. [4][5][6] In fact, an unexpectedly high retear rate was reported with current medial knot-tying technique, in spite of enhanced time zero biomechanical strength.…”

Section: Introductionmentioning

confidence: 99%

“…With advance in arthroscopic technique, various repair methods have been introduced to provide better repair configuration and clinical success. 2,[4][5][6][7] Most studies focused on the technical aspect to enhance biomechanical strength at time zero. 2,3,7) Medial row configuration is of particular interest since the biomechanical strength is known to be affected by the mode of medial cuff grasping.…”

Section: Introductionmentioning

confidence: 99%

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Lee

Ryu²,

Shim

et al. 2015

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2×2 anchor with 4×4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2×2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre-and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears. (Clin Shoulder Elbow 2015;18(4):197-205)

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“…For example, the existence of biological abnormalities beyond the actual site of a rotator cuff tear may also help to explain why repaired tendons may fail further medially following suture bridge repair. 6 However, since suture bridge repairs are often successful, and those that fail may also retear at their lateral insertion, the part played by biomechanical, technical, and anatomic factors in determining the fate of a repaired cuff should not be discounted.…”

mentioning

confidence: 99%

Άπόπτωσις

Reider¹

2013

Am J Sports Med

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Paper 180: Retear Patterns After Arthroscopic Rotator Cuff Repair: Single Row Repair Technique vs. Suture Bridge Technique

Cited by 79 publications

References 0 publications

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

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