Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair?

Abstract

Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have been widely accepted because of their superior biomechanical properties when compared with arthroscopic single-row repair. Concerns regarding repair overtensioning with medial-row knot tying have led to increased interest in knotless repair techniques; however, there is a paucity of clinical data to guide the choice of technique. Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will demonstrate lower retear rates and greater improvements in the Constant score relative to conventional knot-tying TOE techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Inclusion criteria were English-language studies that examined repair integrity or Constant scores after arthroscopic rotator cuff repair with TOE techniques. Two investigators independently screened results for relevant articles. Data regarding the study design, surgical technique, retear rate, and Constant shoulder score were extracted from eligible studies. A quality assessment of all articles was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The systematic review identified a total of 32 studies (level of evidence, 1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5 reported on knotless TOE techniques, 25 reported on knot-tying TOE techniques, and 2 reported on both. In the knotless group, retear rates ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative) to 73-83 (postoperative). In the knot-tying group, retear rates ranged from 0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96 (postoperative). Conclusion: Despite several theoretical advantages of knotless TOE repair, both knotless and knot-tying techniques reported considerable improvement in functional outcomes after rotator cuff repair. Although tendon failure rates showed a downward trend in knotless studies, additional prospective studies are warranted to better understand the role of medial-row fixation on tendon repair integrity and postoperative clinical outcomes.

Preoperative Lymphocyte to Monocyte Ratio Can Be a Prognostic Factor in Arthroscopic Repair of Small to Large Rotator Cuff Tears

“…In our study, preoperative LMR was not related to postoperative retear. Previous systematic reviews have found that for nonmassive RCTs, the retear rate averaged approximately 20% 13 and ranged from 0% to 48%. 25 Regarding the retear rate for small to large RCTs, Kim et al 29 reported 0% at a mean follow-up of 21.9 months, and Mihata et al 41 reported a range of 3.5% to 9.1% at 2 years after RCT.…”

Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure

“…32,33 Consequently, better tendon healing after TOE repairs has been observed in a sheep model when compared with healing after SR and DR repairs. 35 As a result of these findings and due to their excellent clinical results, 12,30,34 TOE repair techniques are now preferred by many surgeons. 11,36,40 Nevertheless, TOE as well as DR repairs can lead to a more severe failure mode with retear of the rotator cuff not at its insertion site on the greater tuberosity but medial to it at the level of the medial row anchors or the musculotendinous junction.…”

How to Maximize Suture Tension in Double-Row Suture-Bridge Rotator Cuff Repair?

“…On the contrary, a retrospective study by Burns et al 10 found that knotted technique for rotator cuff repair required more surgical time than knotless technique, and in another study, Elbuluk et al 11 found that the rate of tendon failure in knotted repair could be the cause of failed rotator cuff repair. However, Sheean et al 12 suggested that the authors of some studies need to be cautious when interpreting results regarding failure of the knotted technique because of the variety of techniques of knot-tying.…”