Tight medial knot tying may increase retearing risk after transosseous equivalent repair of rotator cuff tendon

Sano, Hirotaka; Tokunaga, Masako; Noguchi, Mitsuru; Inawashiro, Takashi; Irie, Taichi; Abe, Hiroo; Yokobori, A. Toshimitsu

doi:10.3233/bme-171673

Cited by 10 publications

(12 citation statements)

References 38 publications

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“…Busfield et al demonstrated that although lateral row knotless fixation has been shown not to sacrifice the structural integrity of this construct, the addition of a knotless medial row compromises the construct leading to greater gapping and failure at lower loads [ 2 ]. In contrast, Sano et al revealed that higher stress concentrations exist around the medial anchor in the double-row fixation, suggesting a biomechanical disadvantage of the medial knot tying [ 18 ]. Taken together, these reports suggest that although medial knot tying offers a biomechanical advantage, a high stress concentration at the tying site affects tendon integrity after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The present study revealed similar results; however, the number of incompletely healed tendons at the final follow-up was significantly greater in the WMT group than in the WOMT group. Unlike the medial-tying suture bridge, the knotless suture bridge not only restored the pressured footprint, but also reduced the tension overload of the suture-tendon interface in the medial row [ 18 , 19 ]. This reduces the possibility of strangulation and subsequent necrosis of the tendon at the medial row [ 4 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this technique, knot tying in a medial row is often performed because of its biomechanical advantage [ 14 , 21 ]. On the contrary, a basic study pointed out the disadvantages of this process evidenced by strangulation due to the medial tying [ 14 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and structural outcomes after arthroscopic rotator cuff repair: a comparison between suture bridge techniques with or without medial knot tying

et al. 2018

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PurposeTo compare arthroscopic suture bridge (SB) techniques with medial tying to those without tying, considering clinical and structural outcomes.MethodsWe included 124 patients with rotator cuff tears after arthroscopic rotator cuff repair (ARCR). Fifty-three patients with clinical and structural evaluations 3, 12, and 24 months postoperatively were included and divided into 29 patients with medial tying (WMT group) and 24 without tying (WOMT group). Clinical outcomes comprised the University of California Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcomes were evaluated with magnetic resonance images (MRI) using Sugaya classifications.ResultsJOA and UCLA scores in the WMT and WOMT groups improved significantly from before surgery to 24 months after surgery (P < 0.01, respectively). No significant difference was noted between groups. No significant postoperative retears (Sugaya types 4 and 5) between WMT and WOMT groups were noted at 3 months (5 vs 3 cases), 12 months (6 vs 5 cases), and 24 months (7 vs 6 cases) postoperatively. Complete healing (Sugaya type 1) was noted at 3 months (8 vs 11 cases), 12 months (10 vs 10 cases), and 24 months (8 vs 13 cases, P = 0.024) postoperatively. Incomplete healing (Sugaya types 2 and 3) were noted at 3 months (16 vs 10 cases), 12 months (13 vs 9 cases), and 24 months (14 vs 5 cases, P = 0.024) postoperatively.ConclusionClinical outcomes for both techniques were comparable, but the number of incompletely healed tendons in SB with medial tying was significantly larger at 24 months after surgery.Level of evidenceThis study is a level III, case-control study.Clinical relevanceThis study revealed the influence of medial tying in rotator cuff repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and structural outcomes after arthroscopic rotator cuff repair: a comparison between suture bridge techniques with or without medial knot tying

et al. 2018

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“…The knotless linkage allows equal load sharing across the repair by using the anchors as pulleys to potentiate the strength of repair. 3 , 9 , 10 , 16 , 20 , 24 , 42 …”

Section: Discussionmentioning

confidence: 99%

“…The knotless linkage allows equal load sharing across the repair by using the anchors as pulleys to potentiate the strength of repair. 3,9,10,16,20,24,42 Prior studies utilizing linked medial row anchors have been limited to biomechanical studies and technique papers, making the present study the first to report on clinical outcomes after a linked double-row equivalent rotator cuff repair. There were statistically significant improvements in all PRO scores, with the ASES score significantly improving from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes

Endo

Hoogervorst

Safranek

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs. Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05. Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively ( P < .001). The QuickDASH ( P < .001), SST ( P < .001), and VAS ( P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up. Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.

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Transosseous Tunnel: Which Arthroscopic Technique?

Chillemi

Castagna

Osimani

2018

Arthroscopic Transosseous Rotator Cuff Repair

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Tight medial knot tying may increase retearing risk after transosseous equivalent repair of rotator cuff tendon

Abstract: In the knotted TOE repair, tight medial knot tying might cause a high stress concentration around medial knots, which may constitute one of the pathogenetic factors of postoperative retearing at this site.

Cited by 10 publications

References 38 publications

Clinical and structural outcomes after arthroscopic rotator cuff repair: a comparison between suture bridge techniques with or without medial knot tying

Clinical and structural outcomes after arthroscopic rotator cuff repair: a comparison between suture bridge techniques with or without medial knot tying

Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes

Transosseous Tunnel: Which Arthroscopic Technique?

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