Suture Slippage After Arthroscopic Cuff Repair: Medial Displacement of Suture Knots on Follow-up Ultrasonography

Abstract

Background: Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear. Purpose/Hypothesis: To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique. Our hypothesis was that the suture would pull out of the lateral anchor (suture slippage), changing the positions of the medial suture knots during healing. Study Design: Case series; Level of evidence, 4. Methods: This study included 53 patients (55 shoulders) who underwent arthroscopic suture-bridge repair and were evaluated for a minimum of 24 months. On serial ultrasonography, a straight line was drawn between the top of the greater tuberosity and the medial cortex of the anchor hole. The distances between the knots of the medial rows and the perpendicular line through the center of the anchor hole were measured in longitudinal plane images of the supraspinatus. Follow-up ultrasonography was performed at 2, 3, and 6 months postoperatively as well as at the final visit. The visual analog scale, the American Shoulder and Elbow Surgeons score, the Constant score, and the University of California, Los Angeles shoulder score were recorded preoperatively and on the final follow-up. Results: Of the 55 shoulders, 6 developed retears at repaired sites. The mean follow-up duration was 37.5 months (range, 24-65 months). Slippage distance increased significantly over time ( P < .001). The slippage at the final visit did not differ between patients with retear and no retear (13.4 mm for retear group; 10.6 mm for no retear group [ P = .096]). Conclusion: Suture knots of the medial row migrated medially via a suture pullout from the lateral row anchor of suture-bridge technique. Suture slippage distance did not differ significantly between retear and no retear groups.

Biomechanical effect of increased number of suture strands on rotator cuff repair in a bovine model

“…Gap formation has been proven to be related to the retear rate after RC repair. 23 The current study revealed that 4 groups showed similar load at the same gap formation. The results suggest that the number of sutures does not appear to be a risk factor for gap formation when using a transosseous technique at time 0.…”

Facile and rapid fabrication of a novel 3D-printable, visible light-crosslinkable and bioactive polythiourethane for large-to-massive rotator cuff tendon repair

“…Suture tear through of tendon is the most frequent mode of failure in rotator cuff repair [ 25 , 34 , 35 ] and therefore vital for ensuring repair construct integrity post-surgery. To determine the suture retention properties of PHT polymer, ADM and 3D-printed PHT scaffold fabricated from 4h-PHT, which best mechanically mimics human SST, were assessed by measuring suture migration during load-to-failure tensile tests ( Fig.…”