Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 ( ClinicalTrials.gov identifier).

BACKGROUND: The rationale behind the decision-making on which type of fixation to use in displaced medial epicondyle fractures is not well elucidated. This study aims to compare the long-term clinical and radiographic outcomes of internal fixation with either Kirschner wires (K-wires) or cannulated screws in children with displaced medial epicondyle fractures. METHODS: In this study, 42 consecutive children who underwent surgical treatment for medial epicondyle fractures displaced more than 5 mm were categorized into two groups as follows: group A, 22 children undergoing fixation with K-wires and group B, 20 children undergoing fixation with a screw. The mean age was nine (median, 10.5; range, 6-14) years in group A and 15 (16, 10-17) in group B. The overall follow-up was 10 (median, 10; range, 5-15) years. To assess patients' clinical outcomes, the Mayo Elbow Performance Scores (MEPS) were used in addition to the elbow range of motion (ROM) at the last follow-up. During the radiographic assessment, possible deformities secondary to the epicondyle fracture were examined on final follow-up radiographs. RESULTS: The main MEPS were 95 (median, 95; range, 85-100) and 93 (94, 85-100) in groups A and B, respectively (p=0.18). In ROM, no significant differences were observed (p=0.43). In the radiographic assessment, one patient from each group developed a fibrous union, and one from each group had hypoplasia. There was no significant relationship between the deformity and fixation type (p=0.34, χ 2 test). CONCLUSION: Two smooth K-wires for younger children and screw fixation for children near skeletal maturity may provide favorable clinical and radiological outcomes at long-term follow-up, with low morbidity and radiographic deformity.

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Purpose Arthroscopic rotator cuf repair (aRCR) is a commonly performed procedure and has been reported to be a successful treatment. Successful healing has traditionally been considered to be associated with good outcome; however, knowledge on predictive factors afecting inal outcome other than tendon healing is limited. This study aims to investigate predictive factors inluencing clinical outcome following aRCR in patients with successfully healed tears. Methods This retrospective case-control study was conducted in a single center with 135 patients who had successfully healed tendons based on Sugaya classiication (grades I-III) on postoperative magnetic resonance imaging (MRI) scans following aRCR. Clinical outcome measures included Constant-Murley score (CMS), range of motion (ROM), pain score. Various preoperative, intraoperative factors and degree of postoperative tendon healing were assessed to identify independent predictive factors for inal clinical outcome. Results Mean age of patients was 55.9 ± 9.0 years and mean follow-up duration was 46.8 ± 14.9 months. There were 50 (37%) male and 85 (63.0%) female patients. At inal follow-up, mean CMS was 85.7 ± 12.0. Considering mean postoperative CMS and the minimal clinically important diference (MCID) of 10 points for CMS, a cutof level of 75 points for CMS was set (85-10 = 75) and study population was divided into two study groups (group I, poor outcome, CMS ≤ ;75, and group II, good outcome, CMS > 75). There were 24 (17.8%) patients in group I and 111 (82.2%) patients in group II. Univariate analysis revealed that gender, body mass index (BMI) and degree of tendon healing (Sugaya classiication) difered signiicantly between two groups (p < 0.05). Multivariate logistic regression analysis which was conducted with these variables showed that female gender (odds ratio 3.65) and Sugaya grade III (odds ratio 8.19) were independent predictive factors which were signiicantly associated with poor outcome (p < 0.05). Conclusions This study showed that despite achieving a successful healing, considerable amount of patients (17.8%) have ended up with poor outcome. Female gender and degree of tendon healing were identiied as independent predictive factors for poor outcome. These data would help surgeons during decision-making, risk assessment and patient counseling. Level of evidence III.