Arthroscopic knotless rotator cuff repair: Factors associated with construct selection and recent trends from a manual review of 1617 cases

Shah, Sarav S.; Shah, Aalok; Chadayammuri, Vivek; McGill, Marlena; Wei, Nicole; Tuckman, David V.; Sgaglione, Nicholas A.

doi:10.1016/j.jor.2018.01.037

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Surgical data included nature of concomitant procedures (ie, use of allograft, biceps tenodesis, capsular release), American Society of Anesthesiologists score (1 or 2 versus ≥3), number of anchors used, history of prior ipsilateral or contralateral nonarthroscopic shoulder surgery, prior ipsilateral or contralateral arthroscopic shoulder surgery, subsequent upper or lower extremity arthroscopy, and any ipsilateral revision surgery. The number of anchors placed was used as a surrogate for rotator cuff tear size based on the findings of Shah et al 21 Procedures were categorized as primary repair of the rotator cuff with or without decompression/débridement (type 1) versus those with concomitant use of allograft (superior capsular reconstruction, lower trapezial tendon transfer, collagen bioinductive allograft augmentation), biceps tenodesis, or distal clavicle excision (type 2). Regarding postoperative follow-up visits, patients were routinely scheduled at 1, 3, 6 weeks, 3, 6, and 12 months.…”

Section: Methodsmentioning

confidence: 99%

Missed Short-term Follow-up After Arthroscopic Rotator Cuff Surgery: Analysis of Surgical and Demographic Factors

Lee,

Singh,

Chou

et al. 2024

JAAOS Glob Res Rev

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Introduction: Few current studies have examined loss to follow-up after rotator cuff–related shoulder arthroscopy. Understanding the demographic and surgical factors for missed follow-up would help identify patients most at risk and potentially mitigate the onset of complications while maximizing clinical outcomes. Methods: A retrospective review of consecutive rotator cuff arthroscopic procedures with a minimum of 12-month follow-up done by a single, fellowship-trained surgeon was undertaken from February 2016 through January 2022. Demographic patient and surgical data, including age, sex, marital status, self-identified race, and body mass index, were collected. Follow-up at ≤3, 6 weeks, 3, 6, and 12 months was determined. Patient-related and surgical predictors for missed short-term follow-up, defined as nonattendance at the 6 and 12-month postoperative visits, were identified. Results: There were 449 cases included, of which 248 (55%) were women. The median age was 57 years (interquartile range [IQR], 51 to 62). Patients with commercial insurance (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.23 to 0.64; P < 0.001) or workers' compensation (OR, 0.15; 95% CI, 0.05 to 0.43; P < 0.001) were less likely to miss the 6-month follow-up compared with patients with Medicare, whereas increased socioeconomic deprivation (OR, 0.86; 95% CI, 0.77 to 0.97, P = 0.015) was associated with decreased odds of missing that visit. Patients who missed the ≤3 weeks (OR, 1.77; 95% CI, 1.14 to 2.74, P = 0.010) and 3-month (OR, 8.55; 95% CI, 4.33 to 16.86; P < 0.001) follow-ups were more likely to miss the 6-month follow-up. Use of a patient contact system (OR, 0.55; 95% CI, 0.35 to 0.87, P = 0.01) and increased number of preoperative visits (OR, 0.91; 95% CI, 0.84 to 0.99, P = 0.033) were associated with decreased odds of missing the 12-month follow-up. Patients who missed the 6-month follow-up were more likely to miss the 12-month follow-up (OR, 5.38; 95% CI, 3.45 to 8.40; P < 0.001). Conclusion: Implementing an electronic patient contact system while increasing focus on patients with few preoperative visits and who miss the 6-month follow-up can reduce the risk of missed follow-up at 12 months after shoulder arthroscopy.

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Section: Methodsmentioning

confidence: 99%

Missed Short-term Follow-up After Arthroscopic Rotator Cuff Surgery: Analysis of Surgical and Demographic Factors

Lee,

Singh,

Chou

et al. 2024

JAAOS Glob Res Rev

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“…11,16,17,21,26 Nevertheless, there has been an increasing trend in the use of knotless repair techniques over the past decade. 37 In cadaveric and animal studies, knotless transosseousequivalent repair demonstrated superior self-reinforcement (greater progression of footprint compression with increasing tendon loads) compared with medial knot repair. 33,38 In smaller tears ( 1.0 cm), single-row repair has demonstrated good success, but the suture pattern and anchor location influence tendon morphology and footprint re-creation.…”

mentioning

confidence: 99%

Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model

Stone

Luo

Sharma

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory. Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. Study Design: Controlled laboratory study. Methods: A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing. Results: The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied ( P = .15) and untied ( P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor ( P = .16) and double-loaded suture tape and anchor ( P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied. Conclusion: An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors. Clinical Relevance: Both tied and untied medial rows demonstrated similar pressures across the repair construct.

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Arthroscopic knotless rotator cuff repair: Factors associated with construct selection and recent trends from a manual review of 1617 cases

Abstract: There was a significant increase from 2009 to 2016 in SR knotless and double row medial row knotless constructs contrasting the declining use of the SR knotted technique.

Cited by 2 publications

References 22 publications

Missed Short-term Follow-up After Arthroscopic Rotator Cuff Surgery: Analysis of Surgical and Demographic Factors

Missed Short-term Follow-up After Arthroscopic Rotator Cuff Surgery: Analysis of Surgical and Demographic Factors

Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model

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