Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Abstract

Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2×2 anchor with 4×4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2×2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre-and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears. (Clin Shoulder Elbow 2015;18(4):197-205)

Does the Dog-Ear or Bird-Beak Deformity Remodel After Rotator Cuff Repair?

“…3 To avoid excessive medial row strangulation, a minimal or interval-tie construct may be useful in the suture bridge technique. 12 Using the appropriate number of sutures to form a durable construct is vital for successful repair, and selecting the correct number to provide favorable outcomes after arthroscopic RC repair using the suture bridge technique is a constant challenge for shoulder surgeons.…”

“…An interval tie construct was formed to avoid medial row strangulation. 12 The first lateral anchor position was the posterior aspect of the bicipital groove, and the distance from the footprint to the lateral anchor was determined according to the size and pattern of the RC tear, shape of the greater tuberosity, and repair configuration that allowed the polyethylene sutures to compress the tendon properly on the footprint. The second lateral anchor position was determined based on the repair configuration and RC tear characteristics.…”