Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

Abstract Background: Rotator cuff tear with delamination is considered as a risk factor for postoperative retear after rotator cuff repair. The purpose of this study was to compare clinical outcomes between 3 repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and combination of double-layer suture bridge and modified Debyere-Patte (DLSB+DP) methods.Methods: A total of 53 shoulders of 52 patients who had large or massive rotator cuff tears with delamination were included. The patients were categorized into 3 groups: EMSB group comprised 18 patients, DLSB group comprised 24 shoulders of 23 patients, and DLSB+DP group comprised 11 patients. DP was applied for cases in which the rotator cuff was unable to be covered up to the footprint even though it was sufficiently mobilized. The mean postoperative follow-up period was 34.6 months (range, 24-72 months). Pre- and postoperative evaluations included the Constant scores and range of motion (ROM). Tendon integrity according to Sugaya classification, and fatty degeneration were also evaluated by magnetic resonance images (MRI).Results: The ROM significantly improved after the operation in all groups. Mean constant scores significantly improved (from 45.5±14.3 to 77.4±13.6, in the EMSB, from 45.5±11.6 to 87.6±11.4 in the DLSB, and from 46.3±11.2 to , and 88.0±10.5 in the DLSB+DP). Significant differences were noted in the postoperative Constant score (p<0.05: DLSB vs. EMSB , and p<0.05: DLSB+DP vs. EMSB)． The Constant pain score was better in the DLSB+DP than in the EMSB group. The mean pre-operative global fatty degeneration index was 1.52 in the EMSB group, 1.80 in the DLSB group, and 2.28 in the DLSB+DP group. Retear occurred in 27.8% in the EMSB group, 12.5% in the DLSB group, and 9.1% in the DLSB+DP group. Conclusions: Comparison of 3 groups demonstrated that DLSB and DLSB+DP achieved better clinical outcome than EMSB. DLSB+DP is useful for large or massive rotator cuff tears with severe fatty degeneration or for cases where presence of excessive tension is anticipated when repairing the torn cuff.

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Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02847-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wei Wang ◽

Hui Kang ◽

Hongchuan Li ◽

Jian Li ◽

Yibin Meng ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Risk Ratio ◽

Healing Rate ◽

Meta Analysis ◽

Credible Interval ◽

Comparative Efficacy ◽

Suture Bridge ◽

Cuff Tear ◽

Arthroscopic Rotator Cuff

Abstract Background Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason–Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. Methods A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com, and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. Results Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle–Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. Conclusion Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.

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