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

Lee,  Hyun Il; Ryu,  Ho Young; Shim,  Sang Jun; Yoo,  Jae Chul

doi:2015.18.4.197

Clin Shoulder Elb > Volume 18(4); 2015 > Article

Original Article

Clinics in Shoulder and Elbow 2015;18(4):197-205.
DOI: https://doi.org/10.5397/cise.2015.18.4.197 Published online December 31, 2015.

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

Hyun Il Lee, Ho Young Ryu, Sang Jun Shim, Jae Chul Yoo

¹Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. shoulderyoo@gmail.com
²Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan Collage of Medicine, Gangneung, Korea.

Received: 26 September 2014 • Revised: 9 December 2014 • Accepted: 13 December 2014

Abstract

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 (2x2 anchor with 4x4 suture stands).
METHODS
From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 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.

Key Words: Rotator cuff; Tendon; Suture anchor; Shoulder; Arthroscopy