Delaminated Rotator Cuff Tears Showed Lower Short-term Retear Rates After Arthroscopic Double-Layer Repair Versus Bursal Layer–Only Repair: A Randomized Controlled Trial

Abstract

Background: The rotator cuff is known to consist of 2 macroscopically visible layers that have different biomechanical properties. Sometimes the inferior layer may be neglected during rotator cuff repair. However, it is controversial whether double-layer (DL) repair is superior to single-layer (SL) repair in terms of retear rate and outcome. Purpose: To investigate whether DL as compared with SL repair could decrease retear rates after arthroscopic reconstruction of posterosuperior rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 70 patients were 1:1 randomized to receive an arthroscopic DL reconstruction (study group: DL suture-bridge repair) or SL reconstruction (control group: SL suture-bridge repair) for posterosuperior tears of the rotator cuff between 2.0 and 3.5 cm of the footprint detachment. Exclusion criteria were subscapularis tendon rupture (Lafosse >1°), fatty muscular infiltration >2°, and nondelaminated tendons. Tendon integrity according to Sugaya, fatty degeneration, and muscular atrophy were evaluated by magnetic resonance tomography. Pre- and postoperative evaluations included the Constant score, range of motion, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and postoperative satisfaction with the procedure. Complications were monitored throughout the study. Results: Ninety percent of patients (n = 34, DL; n = 29, SL) were followed-up. There were no significant group differences regarding baseline characteristics and pre- and postoperative fatty degeneration of the supraspinatus and atrophy of the supraspinatus and infraspinatus. The rate of magnetic resonance–verified intact repairs (Sugaya grades 1 + 2) was significantly higher in the DL group (70.6%) than in the SL group (44.8%; P = .045). One patient in the control group with a retear underwent revision. All functional and subjective scores improved significantly pre- to postoperatively in both groups ( P < .05). No significant group differences were detected regarding postoperative Constant score, forward flexion, external rotation, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and visual analog scale and between intact and retorn tendons. The majority of patients were very satisfied or satisfied with their arthroscopic procedure (DL, 94.1%; SL, 92.9%). Conclusion: This randomized controlled trial showed significantly lower retear rates after DL repair as compared with SL repair in delaminated rotator cuff tears. Clinical short-term outcome was not different between the DL and SL repair groups. Registration: NCT003362320 (ClinicalTrials.gov identifier).

Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation

“…Several reports since 2005 agreed that the presence of delaminated tears is a negative prognostic factor in functional and morphologic results after the repair of rotator cuff tendons [ 14 , 15 , 16 , 29 , 32 , 35 , 36 ]. An improvement in biomechanical properties, improved clinical outcomes, and decreased retear rates have been reported for the repair of delaminated tears [ 31 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. The intratendinous laminated component of rotator cuff tears should be repaired using a number of surgical techniques to restore normal biomechanics of the cuff and reduce the risk of repair failures [ 10 ].…”

Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

“…Mochizuki et al reported that the super cial and deep layers should be individually sutured because the footprints of the 2 layers are anatomically different [11,14]. Some studies have described the usefulness of DLSB, comparing with EMSB and the bursal layer-only repair suture bridge (BLSB) [6,8,35,36]. This is based on the merit of DLSB in repairing the super cial and deep layers to an anatomically appropriate footprint [35].…”

“…The delamination of the rotator cuff has been described as a horizontal lesion between the super cial and deep layers [1,2]. Delamination is observed in 36-82% of rotator cuff tear cases [3][4][5][6][7][8][9] and its presence is considered a risk factor for postoperative retear after rotator cuff repair [4]. Double-row double layer xation was reported as a repair method of the stump of delaminated rotator cuff tears, but a high incidence of retear in large and massive rotator cuff tear cases has been known [2,10], and optimal xation method for rotator cuff stump with delamination has yet been under debate.…”

No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears

“…Although diagnostic methods and surgical techniques have developed significantly over the last decade, non-healing and retear rates of surgically repaired tendons are still unacceptably high [ 6 , 15 , 16 , 35 , 37 ]. This has led to a growing interest in aetiology of tendon tearing and biology of healing.…”