Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes

Abstract

Background: Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected. Purpose: To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff. Results: The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively ( P < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively ( P < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%. Conclusion: Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.

Arthroscopic Autologous Coracoacromial Ligament Augment Technique for Particle Thickness of Rotator Cuff with at Least Two Years Follow‐Up

“…The midterm outcomes showed that the shoulder function also increased significantly (ASES: 52 AE 14 to 94 AE 5; SST: 6 AE 2 to 11 AE 1). 26 Compared to the precious research, our study also showed the good clinical results (mean ASES: 57.3 to 95.0; mean SST: 5.3 to 10.0). It demonstrated that the transferred CA ligament as an augmentation is effective for PTRCTs.…”

“…Meanwhile another study explored the transtendon suture bridge repair in PTRCTs. The midterm outcomes showed that the shoulder function also increased significantly (ASES: 52 ± 14 to 94 ± 5; SST: 6 ± 2 to 11 ± 1) 26 . Compared to the precious research, our study also showed the good clinical results (mean ASES: 57.3 to 95.0; mean SST: 5.3 to 10.0).…”

Effects of Arthroscopic Atelocollagen Insertion in High-Grade Partial Articular Supraspinatus Tendon Avulsion Lesions: A Retrospective Cohort Study With Propensity Score Matching

“…The 301 patients were classified into the following 2 groups based on atelocollagen insertion in patients who underwent arthroscopic rotator cuff repair of high-grade PASTA lesions: group 1 (226 patients treated with arthroscopic repair without atelocollagen augmentation) and group 2 (75 patients treated with arthroscopic repair with atelocollagen augmentation). 26 , 28 The group 2 patients were then matched to group 1 patients in a 1:1 format using propensity score matching, with sex, age, body mass index, trauma history, and tear size (anteroposterior and lateral) as matching characteristics (68 patients per group) ( Figures 1 and 2 ).…”

“…Arthroscopic transtendon repair of PASTA lesions has shown good clinical outcomes. 9,19,26,28 Compared with the normal tendon thickness, high-grade PASTA lesions showed high-grade articular-side tears (Ellman grade 3) compatible with a thin rotator cuff thickness. Also, even though a repair was performed, residual shoulder discomfort often persisted.…”

Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears

“…All patients underwent MRI evaluation at 3 months and 12 months postoperatively. The results were interpreted according to the Sugaya classification, and types IV and V were considered postoperative retears [25, 30]. For patients with retears, the retear size was measured as the maximum anteroposterior length on sagittal oblique views and the maximum medial‐to‐lateral length on coronal oblique views [10].…”