Clinical Comparative Study on the Treatment of Inferior Pole Fractures of Patella by Double-row Anchor Suture Bridge Technique Combined with Kirschner Wire Tension Band Internal Fixation

Objective: To investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella, and to compare it with traditional Kirschner wire tension band internal fixation. Methods: General information A total of 62 patients were enrolled in this study, including 35 males and 27 females, aged 31-80 years old, with an average of (53.2±4) years old. All the patients were divided into two groups by a random double-blind method: Group A (double-row anchor suture bridge technique group) and Group B (Kirschner wire tension band internal fixation group), with 32 cases and 30 cases in each group, respectively. The two techniques were performed by the same group of doctors to fix the fracture respectively, and the intraoperative bleeding, operation time, incidence of postoperative complications, knee function score, etc., were compared between the two techniques. Results: Group A (double-row anchor suture bridge technique group): operation time 56-80min, with an average of (60±10) min; intraoperative blood loss 30-56ml, with an average of (43±10) ml. All incisions healed in one stage and stitches were removed after 2 weeks. No complications such as incision infection, flap necrosis and nerve injury occurred. The average healing time of the fracture was 12 weeks. At the last follow-up, the Bostman score was (28.5±3.3), and the excellent rate was 93.7%. Group B (Kirschner wire tension band internal fixation group): operation time 54-76min, with an average of (56±10) min; intraoperative blood loss 31-50ml, with an average of (43±80) ml. One patient developed delayed incision healing postoperatively. Four patients experienced Kirschner wire withdrawal, one of which was accompanied by infection. Two patients were found to have mild separation of distal fracture fragments, despite the fracture being fine. The average healing time of the fracture was 13 weeks. At the last follow-up, the Bostman score was (23.5±3.3), and the excellent rate was 86.7%. Conclusion: Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients’ requirements for early postoperative ambulation. This technology is superior to traditional Kirschner wire tension band internal fixation owing to its advantages of no need to take out the internal fixation, firm fixation, no need to worry about Kirschner wire withdrawal and fewer complications, and its clinical efficacy satisfaction rate is also better than traditional surgical methods. In short, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.

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

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.

Clinical Outcomes and Repair Integrity after Arthroscopic Full-thickness Rotator Cuff Repair: Traditional Suture-bridge Versus Novel Modified Suture-bridge Technique

Background: This prospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the traditional suture bridge technique and the modified suture bridge technique.Methods: From December 2018 to December 2019, 50 consecutive cases of full-thickness medium rotator cuff tear, 1 to 3 cm in the coronal plane, for which arthroscopic rotator cuff repair was performed, were included. The TSB technique was used in 24 consecutive shoulders; and the MSB technique, in 26 consecutive shoulders. Clinical outcomes at 3 months, 6 months and a minimum of 1 years (mean, 11.92±1.92months) were evaluated postoperatively using range of shoulder, the visual analog scale score; University of California Los Angeles Shoulder Scale score; Constant-Murley shoulder score and American Shoulder and Elbow Surgeons Subjective Shoulder Scale score. All patients underwent preoperative MRI and B-US to identify the rotator cuff tear, and postoperatively at final follow-up to evaluate tendon integrity. Results: At the final follow-up, the clinical outcomes improved in both groups. There were no significant differences in the results of the ROM between the two groups at 3 months, 6 months and the final follow-up. The average VAS score decreased from 6.12±0.95 to 1.04±0.45 in MSB Group and decreased from 6.29±0.91 to 1.33±0.48 at the final follow-up in TSB Group. The VAS score significantly differed between the two groups only at the final follow-up (P=0.03). The mean UCLA score increased from 12.23±3.47 to 30.96±2.54 in MSB Group and increased from 11.50±4.00 to 28.79±4.47 in TSB Group at the final follow-up; the mean Constant shoulder score increased from 40.54±5.61 to 92.08±7.21 in MSB Group and increased from 41.79±5.51 to 86.96±8.42 in TSB Group at the final follow-up. The average ASES score increased from 36.04±2.47 to 96.04±7.28 in MSB Group and increased from 35.04±3.10 to 91.50±7.33 in TSB Group at the final follow-up. The UCLA (P=0.044), Constant (P=0.025), ASES (P=0.033) score significantly differed between the two groups only at the final follow-up. At the final follow-up postoperatively, the MRI assessments showed no retear in MSB Group and two retears in TSB Group (8%)(Z=-1.538, P=0.124), B-US assessments showed no retear in MSB Group and one retear in TSB Group (4%)(Z=-1.169, P=0.242). No significant difference was found between the 2 groups regarding cuff integrity in accordance with MRI assessments and B-US assessmentsConclusion: For medium-sized RCTs, the patients who underwent MSB repair had shown better shoulder functional outcomes and a lower but not significant re-tear rate with those who underwent TSB repair. Therefore, the MSB repair technique can be considered an effective treatment for patients with medium-sized full-thickness RCTs.ClinicalTrials.gov Identifier: NCT04825249 Level of evidence: A prospective study, Level II.

All-Suture and Solid Medial Row Anchors Produce Similar Clinical Outcomes for Double Row Suture Bridge Rotator Cuff Repair (227)

Objectives: All-suture anchor use for rotator cuff repair is increasing. Potential benefits of these anchors include less bone loss from anchor hole drilling and decreased injury to the chondral surface with anchor pullout. Minimal evidence exists comparing clinical outcomes of all suture to solid medial row anchor fixation in double row suture bridge rotator cuff repair. The purpose of this study was to compare patient-reported outcomes for rotator cuff tears treated with all-suture medial row anchors to those treated with more traditional solid anchors. The null hypothesis was that there is no difference in outcomes between the all-suture and solid anchor rotator cuff repairs. Methods: Three sports medicine fellowship trained surgeons performed rotator cuff repairs using the double row suture bridge technique with minimum 3 years of follow up. Patients were separated into two groups based on whether or not they received all-suture or solid anchor fixation for the medial row of their repair. All lateral row fixation was performed with solid anchors. Primary outcomes were evaluated with telephone follow-up and included the American Shoulder and Elbow Surgery Score (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS). The Rehabilitation protocol was the same for all subjects in the study. Results: 3 sports medicine fellowship trained orthopaedic surgeons performed 153 rotator cuff repairs. 91 of these subjects had all-suture fixation of the medial row and 62 received solid anchor fixation. Follow up was 3.6 years ± 0.6 for the all-suture group and 3.7 years ± 0.6 in the solid anchor group (p= 0.28). ASES scores were 92 ± 16 in the all-suture group and 90 ± 17 in the solid group (p =0.35). SANE scores were 91 ± 13 in the all-suture and also 91 ± 13 in the solid anchor cohort (p = 0.97). VAS scores were 1.1 ± 2.0 in the all-suture and 0.7± 1.8 in the solid anchor group (p=0.17). There were no significant differences between groups with regards to re-operation rate or anchor configuration. Conclusions: All suture anchors used in medial row fixation for double row suture bridge rotator cuff repairs have similar clinical outcomes to rotator cuff tears treated in similar fashion with solid medial row anchors.

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

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.