Arthroscopic Rotator Cuff Repair: Double-Row Transosseous Equivalent Suture Bridge Technique

Abstract

Following a failed course of conservative management, arthroscopic rotator cuff repair (ARCR) has become the gold standard treatment for patients presenting with symptomatic rotator cuff (RC) tears. Traditionally, the single-row repair technique was used. Although most patients enjoy good to excellent clinical outcomes, structural healing to bone remains problematic. As a result, orthopaedic surgeons have sought to improve outcomes with various technological and technical advancements. One such possible advancement is the double-row technique. We present a method for repairing an RC tear using double-row suture anchors in a transosseous equivalent suture bridge technique. The doublerow technique is believed to more effectively re-create the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. However, it requires longer operating times and is costlier. This report highlights this technique for ARCR in an adult by using a double-row transosseous equivalent suture bridge.

Effect of Smoking on Healing Failure After Rotator Cuff Repair

“…No patients underwent distal clavicle resection or coracoplasty. A double-row repair with suture-bridge configuration 3,9,38 was performed in all patients.…”

Histological evaluation of cellular response to a multifilament electrospun suture for tendon repair

“…Traditionally, rotator cuff repairs were performed via an open approach, using sutures grasping the tendon edge, passed through bone tunnels in the greater tuberosity, and secured with knots [4]. With improved understanding of the biomechanical environment and tear patterns, surgeons now employ a number of newer implant options and repair constructs, to help drive the best possible anatomical reconstruction of the tendon-to-bone interface [5][6][7][8][9]. Despite these advances, healing of the tendon to the bony footprint occurs in only 60% of cuff repairs and is influenced by age and tear size [10].…”

“…These can either be tied down (knotted repair), or hold the tendon in place without the need for knots (knotless repair) [13]. Some surgeons prefer to use a "double row" technique whereby the medial part of the tendon is attached with suture anchors to the medial part of the footprint and the free tendon edge is attached to the lateral part of the footprint using a second, lateral, row of anchors [5]. This double row technique can be linked to the medial row or unlinked, knotted or knotless, or a combination [13].…”

Comparison of Locking-Loop Suture Bridge Repair and Single-Row Suture Anchor Repair in Small to Medium Rotator Cuff Tears: A Prospective Cohort Study With Clinical and Ultrasound Evaluations

“…A total of 83 patients were included in this prospective cohort study. Inclusion criteria were as follows: (1) being aged between 40 and 80 years, (2) having a full-thickness supraspinatus or infraspinatus tendon tear of a small to medium size (tear diameter <3 cm; DeOrio and Cofield 13 classification), (3) having grade 1 or 2 retraction (Patte 37 classification), and (4) having fatty degradation of grade 1 or 2 (Goutallier classification 17 ) on magnetic resonance imaging (MRI). The exclusion criteria were as follows: (1) undergoing combined type 2 superior labral anterior to posterior (SLAP) repair, (2) having a complete rupture of the subscapularis tendon, (3) having neurological involvement, (4) undergoing a revision procedure, (5) having a partial-thickness rotator cuff tear progress to a full-thickness lesion, (6) having advanced arthritic changes in the glenohumeral joint, or (7) having not fully repairable tears.…”