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Does an Arthroscopic Suture Bridge Technique Maintain Repair Integrity?: A Serial Evaluation by Ultrasonography

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Al-Shawi A, Badge R, Bunker T. The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br. 2008;90:889–892.

    Article  CAS  PubMed  Google Scholar 

  2. Anderson K, Boothby M, Aschenbrener D, van Holsbeeck M. Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up. Am J Sports Med. 2006;34:1899–1905.

    Article  PubMed  Google Scholar 

  3. Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ. Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy. 2002;18:519–526.

    Article  PubMed  Google Scholar 

  4. Baums MH, Spahn G, Steckel H, Fischer A, Schultz W, Klinger HM. Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques. Knee Surg Sports Traumatol Arthrosc. 2009 March 21. [Epub ahead of print].

  5. Bennett WF. Arthroscopic repair of full-thickness supraspinatus tears (small-to-medium): a prospective study with 2- to 4-year follow-up. Arthroscopy. 2003;19:249–256.

    Article  PubMed  Google Scholar 

  6. Bianchi S, Martinoli C, Abdelwahab IF. Ultrasound of tendon tears. Part 1: general considerations and upper extremity. Skeletal Radiol. 2005;34:500–512.

    Article  PubMed  Google Scholar 

  7. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66:563–567.

    Google Scholar 

  8. Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis DS, Palladas P, Fezoulidis IV. Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. Eur J Radiol. 2008;68:174–179.

    Article  PubMed  Google Scholar 

  9. Frank JB, ElAttrache NS, Dines JS, Blackburn A, Crues J, Tibone JE. Repair site integrity after arthroscopic transosseous-equivalent suture-bridge rotator cuff repair. Am J Sports Med. 2008;36:1496–1503.

    Article  PubMed  Google Scholar 

  10. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86:219–224.

    PubMed  Google Scholar 

  11. Gladstone JN, Bishop JY, Lo IK, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35:719–728.

    Article  PubMed  Google Scholar 

  12. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    PubMed  Google Scholar 

  13. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12:550–554.

    Article  PubMed  Google Scholar 

  14. Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF. Arthroscopic rotator cuff repair with double-row fixation. J Bone Joint Surg Am. 2007;89:1248–1257.

    Article  PubMed  Google Scholar 

  15. Jones CK, Savoie FH 3rd. Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy. 2003;19:564–571.

    Article  PubMed  Google Scholar 

  16. Kilcoyne RF, Reddy PK, Lyons F, Rockwood CA Jr. Optimal plain film imaging of the shoulder im**ement syndrome. AJR Am J Roentgenol. 1989;153:795–797.

    CAS  PubMed  Google Scholar 

  17. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34:407–414.

    Article  CAS  PubMed  Google Scholar 

  18. Klepps S, Bishop J, Lin J, Cahlon O, Strauss A, Hayes P, Flatow EL. Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs. Am J Sports Med. 2004;32:1716–1722.

    Article  PubMed  Google Scholar 

  19. Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O. Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999;8:242–246.

    Article  CAS  PubMed  Google Scholar 

  20. Lafosse L, Brozska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am. 2007;89:1533–1541.

    Article  PubMed  Google Scholar 

  21. Lo IK, Burkhart SS. Arthroscopic revision of failed rotator cuff repairs: technique and results. Arthroscopy. 2004;20:250–267.

    Article  PubMed  Google Scholar 

  22. McNally EG. Practical Musculoskeletal Ultrasound. Philadelphia, PA: Elsevier Churchill Livingstone; 2005.

    Google Scholar 

  23. Meier SW, Meier JD. The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy. 2006;22:1168–1173.

    Article  PubMed  Google Scholar 

  24. Oh JH, Kim SH, Choi JA, Kim Y, Oh CH. Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res. 2009 April 4. [Epub ahead of print].

  25. Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009;25:30–39.

    Article  PubMed  Google Scholar 

  26. Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB. Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med. 2008;36:1310–1316.

    Article  PubMed  Google Scholar 

  27. Park MC, Elattrache NS, Ahmad CS, Tibone JE. “Transosseous-equivalent” rotator cuff repair technique. Arthroscopy. 2006;22:1360.e1–1360.e5.

    Google Scholar 

  28. Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg. 2007;16:461–468.

    Article  PubMed  Google Scholar 

  29. Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ. Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg. 2007;16:469–476.

    Article  PubMed  Google Scholar 

  30. Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C. Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am. 2002;84:2152–2160.

    PubMed  Google Scholar 

  31. Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome comparison. Arthroscopy. 2003;19:234–238.

    Article  PubMed  Google Scholar 

  32. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am. 2007;89:953–960.

    Article  PubMed  Google Scholar 

  33. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997;344:275–283.

    Article  PubMed  Google Scholar 

  34. Wilson F, Hinov V, Adams G. Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up. Arthroscopy. 2002;18:136–144.

    Article  PubMed  Google Scholar 

  35. Yen CH, Chiou HJ, Chou YH, Hsu CC, Wu JJ, Ma HL, Chang CY. Six surgery-correlated sonographic signs for rotator cuff tears: emphasis on partial-thickness tear. Clin Imaging. 2004;28:69–76.

    Article  PubMed  Google Scholar 

  36. Ziegler DW. The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. J Shoulder Elbow Surg. 2004;13:291–297.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank **-Sung Kim, laboratory technician, for assistance with evaluation of muscle strength in this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Konkuk University Hospital, 4-12, Hwayang-dong, Gwang**-gu, Seoul, South Korea

    **-Young Park MD, Jung-Sup Keum MD & Kyung-Soo Oh MD

  2. Institute of Orthopaedics and Traumatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

    Hawa Tahir Siti MD

  3. Department of Radiology, Konkuk University School of Medicine, Seoul, Korea

    Sung-Gyu Moon MD

Authors
  1. **-Young Park MD
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  2. Hawa Tahir Siti MD
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  3. Jung-Sup Keum MD
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  5. Kyung-Soo Oh MD
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Correspondence to Kyung-Soo Oh MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Konkuk University Hospital.

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Park, JY., Siti, H.T., Keum, JS. et al. Does an Arthroscopic Suture Bridge Technique Maintain Repair Integrity?: A Serial Evaluation by Ultrasonography. Clin Orthop Relat Res 468, 1578–1587 (2010). https://doi.org/10.1007/s11999-009-0990-8

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  • DOI: https://doi.org/10.1007/s11999-009-0990-8

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