A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases

Elkins, Ashleigh; Lam, Patrick H.; Murrell, George A. C.

doi:10.1177/2325967119864088

Cited by 10 publications

(17 citation statements)

References 32 publications

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“…Our group previously investigated factors that were predictive of a rotator cuff retear in a cohort of 1000 patients. 12 We found that operative time was a significant independent predictor of rotator cuff retears at 6 months postoperatively. Other factors that were identified to be significant independent predictors of a retear were anteroposterior tear length, mediolateral tear length, tear thickness, and patient age at surgery.…”

Section: Re-tear Ratementioning

confidence: 61%

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Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Elkins

Lam

Murrell

2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic rotator cuff repair can be quite complex and time consuming, particularly early in the surgeon’s learning curve. Hypothesis: Patients who have undergone rotator cuff repair with shorter operative times will be less likely to have a rotator cuff retear at 6 months postoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: This study was an analysis of data from 1600 consecutive patients (670 partial-thickness and 930 full-thickness tears) who had rotator cuff repair performed by a single surgeon utilizing an arthroscopic, single-row, knotless inverted mattress suture anchor technique. All patients underwent ultrasound at 6 months postoperatively to determine repair integrity. Moving average analysis was performed for the variables of operative time and case number to evaluate the surgeon’s learning curve. Results: For early cases, the mean operative time was approximately 35 minutes. After approximately 450 cases, the operative time plateaued at approximately 20 minutes. The mean operative time for the cohort (±SEM) was 22 ± 0.3 minutes, and the mean retear rate was 13%. Increased operative time was associated with a retear ( r = 0.18; P < .001). Multiple logistic regression analysis revealed that the variables with the most independent effect on retears were larger tear size (Wald statistic = 36; P < .001), lower case number (ie, less surgeon experience) (Wald statistic = 28; P < .001), older patient age (Wald statistic = 23; P < .001), full-thickness tears (Wald statistic = 13; P < .001), and lower surgeon-rated repair quality (Wald statistic = 8; P = .004). Operative time was not a significant independent factor contributing to retears. Conclusion: Operative time and rotator cuff retear rates decreased as surgical team experience increased. The hypothesis of this study, however, was not supported. The reduced retear rate was not related to a reduction in operative time per se but rather to improved surgical team experience and patient factors, such as improved healing with smaller tears in younger patients.

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Section: Re-tear Ratementioning

confidence: 61%

“…51 Detailed outcomes of this approach alone are presented elsewhere. 12 In cases where undersurface repair was unable to be completed, the tendon was approached from the side of the subacromial bursa, and a bursal-sided repair technique was utilized. 31 Before repair, partial-thickness tears were converted to full-thickness tears.…”

Section: Surgical Techniquementioning

confidence: 99%

Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Elkins

Lam

Murrell

2020

Orthopaedic Journal of Sports Medicine

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“…The arthroscopic treatment of chronic, massive rotator cuff tears can be technically demanding, with longer operative times, higher costs, and possible increased rerupture rates compared with open treatment [ 8 , 17 ]. Therefore, open and mini-open procedures are still common and frequently used in rotator cuff repair [ 8 ]. Both the SLKS and DLKS are applicable to arthroscopic technique, but less technically demanding in open repair.…”

Section: Discussionmentioning

confidence: 99%

“…Arthroscopic repair techniques have become popular in recent years, with possible advantages in visualization of tears and additional intra-articular lesions, less scar formation, and shorter postoperative recovery [ 4 ]. On the other hand, arthroscopic repair can be technically demanding and time-consuming in comparison with mini-open procedures [ 8 ]. The modified Mason-Allen stitch (mMAS) technique is common in mini-open procedures and considered to be superior to the simple or mattress stitch with respect to initial fixation strength [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches

et al. 2021

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In rotator cuff repair, strong and reliable suturing is necessary to decrease failure rates. The biomechanics of two self-cinching stitches – the single-loop knot stitch (SLKS) and the double-loop knot stitch (DLKS) – and the modified Mason-Allen stitch (mMAS) were compared. Twenty-seven porcine infraspinatus tendons were randomized among the three stitches. Each was cyclically loaded (10–80–200 N for 50 cycles each) while the gap formation was measured. Next, ultimate load to failure was tested. The gap widths after cyclic loading were 8.72 ± 0.93 mm for the DLKS, 8.65 ± 1.33 mm for the mMAS, and 9.14 ± 0.89 mm for the SLKS, without significant differences. The DLKS showed the highest ultimate load (350.52 ± 38.54 N) compared with the mMAS (320.88 ± 53.29 N; p = 0.304) and the SLKS (290.54 ± 60.51 N; p < 0.05). The DLKS showed similar reliability and better strength compared with the mMAS, while the SLKS showed a slight but not significant decrease in performance. In our experience, the DLKS and SLKS have clinical advantages, as they are easy to perform and the self-cinching loop knot allows the surgeon to grasp degenerative tendon tissue. Initial intraoperative tightening of the suture complex (preloading) before locking is important in order to decrease postoperative elongation.

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“…Patients who had (1) irreparable rotator cuff tears, (2) partially repaired rotator cuff tears, (3) rotator cuff tears repaired using interposition grafts or onlay biological patches, (4) isolated subscapularis repairs, (5) rotator cuff repairs associated with calcific tendinitis, or (6) associated fractures or (7) who had undergone concurrent stabilization procedures were excluded. Patients who underwent another operation not related to their index surgery (eg, rotator cuff repair on the other side within 6 months of the index surgery) that would have delayed return to work were also excluded.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Predictors of Return to Work Following Primary Arthroscopic Rotator Cuff Repair: An Analysis of 1502 Cases

et al. 2023

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Background: It is undetermined which factors predict return to work after arthroscopic rotator cuff repair. Purpose: To identify which factors predicted return to work at any level and return to preinjury levels of work 6 months after arthroscopic rotator cuff repair. Study Design: Case-control study; Level of evidence, 3. Methods: Multiple logistic regression analysis of prospectively collected descriptive, preinjury, preoperative, and intraoperative data from 1502 consecutive primary arthroscopic rotator cuff repairs, performed by a single surgeon, was performed to identify independent predictors of return to work at 6 months postoperatively. Results: Six months after arthroscopic rotator cuff repair, 76% of patients had returned to work, and 40% had returned to preinjury levels of work. Return to work at 6 months was likely if patients were still working after their injuries but before surgery (Wald statistic [W] = 55, P < .0001), were stronger in internal rotation preoperatively (W = 8, P = .004), had full-thickness tears (W = 9, P = .002), and were female (W = 5, P = .030). Patients who continued working postinjury but presurgery were 1.6 times more likely to return to work at any level at 6 months compared to patients who were not working ( P < .0001). Patients who had a less strenuous preinjury level of work (W = 173, P < .0001), worked at a mild to moderate level post injury but presurgery, had greater preoperative behind-the-back lift-off strength (W = 8, P = .004), and had less preoperative passive external rotation range of motion (W = 5, P = .034) were more likely to return to preinjury levels of work at 6 months postoperatively. Specifically, patients who worked at a mild to moderate level postinjury but presurgery were 2.5 times more likely to return to work than patients who were not working, or who were working strenuously postinjury but presurgery ( p < 0.0001). Patients who nominated their preinjury level of work as “light” were 11 times more likely to return to preinjury levels of work at 6 months compared to those who nominated it as “strenuous” ( P < .0001). Conclusion: Six months after rotator cuff repair, patients who continued to work after injury but presurgery were the most likely to return to work at any level, and patients who had less strenuous preinjury levels of work were the most likely to return to their preinjury levels of work. Greater preoperative subscapularis strength independently predicted return to work at any level and to preinjury levels.

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A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases

Cited by 10 publications

References 32 publications

Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches

Predictors of Return to Work Following Primary Arthroscopic Rotator Cuff Repair: An Analysis of 1502 Cases

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