Advertisement
Journal of Shoulder and Elbow Surgery

Arthroscopic repair of the medium-size rotator cuff tear with the novel technique of the point union bridge: a minimum 2-year follow-up cohort study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Liangquan Peng
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Jiaji Yue
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Kan Ouyang
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Weimin Zhu
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Kang Chen
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Ying Li
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Daping Wang
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Wei Lu
    Correspondence
    Reprint requests: Wei Lu, MD, PhD, Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002 Sungang W Rd, Shenzhen 518000, China.
    Affiliations
    Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:January 21, 2021DOI:https://doi.org/10.1016/j.jse.2020.12.003

      Background

      Achieving secure fixation and preventing retear have been recognized as fundamental in arthroscopic repair of rotator cuff tears. Moreover, reducing internal implantation can lower medical expenses and minimize the operation time, which is essential for the surgical safety and postoperative rehabilitation of the patients. We have recently proposed the point union bridge (PUB) suture configuration as a novel method for not only providing equivalent fixation but also decreasing the operation time and medical expenses. However, no comparative clinical studies have been performed.

      Methods

      From March 2014 to September 2016, a total of 88 patients with diagnoses of medium-size rotator cuff tears underwent arthroscopic repair with a randomly assigned technique—either the PUB technique (n = 42) or the double-row suture bridge (DRSB) technique (n = 46). All patients underwent a minimal 2-year follow-up. We used the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, active and passive range of motion, and visual pain-simulation score (visual analog scale [VAS] score) to assess the functional outcomes. In addition, we recorded the arthroscopic operation time, medical costs, and postoperative complications. All patients received magnetic resonance imaging at the 6-month and 2-year postoperative evaluations to assess structural integrity and tendon healing.

      Results

      At the 2-year follow-up, all scoring parameters evaluated (CMS, ASES score, and VAS score), as well as active and passive range of motion, improved significantly in both groups as compared with preoperative assessments. The PUB technique significantly decreased the operation time (55.9 ± 14.1 minutes vs. 72.2 ± 14.2 minutes for PUB vs. DRSB, P < .001) and medical expenses ($2608.0 ± $391.1 vs. $4056.9 ± $350.9 for PUB vs. DRSB, P < .001). However, no significant differences between the 2 techniques were found in any functional assessments of the shoulder (CMS, ASES score, and VAS score), repair integrity, or the retear rate at the 2-year follow-up.

      Conclusion

      Arthroscopic repair of the medium-size rotator cuff tear with either the PUB or DRSB technique could yield both satisfactory improvements in the shoulder function of patients and equivalent tendon integrity. With less consumption of internal implants, the PUB technique significantly reduced the operation time and decreased medical expenses.

      Level of evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Ahmad C.S.
        • Kleweno C.
        • Jacir A.M.
        • Bell J.E.
        • Gardner T.R.
        • Levine W.N.
        • et al.
        Biomechanical performance of rotator cuff repairs with humeral rotation: a new rotator cuff repair failure model.
        Am J Sports Med. 2008; 36: 888-892https://doi.org/10.1177/0363546508316285
        • Apreleva M.
        • Ozbaydar M.
        • Fitzgibbons P.G.
        • Warner J.J.
        Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area.
        Arthroscopy. 2002; 18: 519-526https://doi.org/10.1053/jars.2002.32930
        • Bateman J.E.
        The Diagnosis and Treatment of Ruptures of the Rotator Cuff.
        Surg Clin North Am. 1963; 43: 1523-1530https://doi.org/10.1016/s0039-6109(16)37139-0
        • Boileau P.
        • Andreani O.
        • Schramm M.
        • Baba M.
        • Barret H.
        • Chelli M.
        The effect of tendon delamination on rotator cuff healing.
        Am J Sports Med. 2019; 47: 1074-1081https://doi.org/10.1177/0363546519835491
        • Burkhart S.S.
        • Denard P.J.
        • Konicek J.
        • Hanypsiak B.T.
        Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears.
        Am J Sports Med. 2014; 42: 457-462https://doi.org/10.1177/0363546513516602
        • Chalmers P.N.
        Editorial commentary: does a medialized repair allow single-row to outperform double-row rotator cuff repair?.
        Arthroscopy. 2019; 35: 2814-2816https://doi.org/10.1016/j.arthro.2019.06.010
        • Chung S.W.
        • Kim J.Y.
        • Kim M.H.
        • Kim S.H.
        • Oh J.H.
        Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function.
        Am J Sports Med. 2013; 41: 1674-1683https://doi.org/10.1177/0363546513485719
        • Donohue K.W.
        • Ricchetti E.T.
        • Ho J.C.
        • Iannotti J.P.
        The association between rotator cuff muscle fatty infiltration and glenoid morphology in glenohumeral osteoarthritis.
        J Bone Joint Surg Am. 2018; 100: 381-387https://doi.org/10.2106/JBJS.17.00232
        • Duquin T.R.
        • Buyea C.
        • Bisson L.J.
        Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review.
        Am J Sports Med. 2010; 38: 835-841https://doi.org/10.1177/0363546509359679
        • Franceschi F.
        • Ruzzini L.
        • Longo U.G.
        • Martina F.M.
        • Zobel B.B.
        • Maffulli N.
        • et al.
        Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial.
        Am J Sports Med. 2007; 35: 1254-1260https://doi.org/10.1177/0363546507302218
        • Hein J.
        • Reilly J.M.
        • Chae J.
        • Maerz T.
        • Anderson K.
        Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: a systematic review.
        Arthroscopy. 2015; 31: 2274-2281https://doi.org/10.1016/j.arthro.2015.06.004
        • Heuberer P.R.
        • Pauzenberger L.
        • Gruber M.S.
        • Ostermann R.C.
        • Hexel M.
        • Laky B.
        • et al.
        Delaminated rotator cuff tears showed lower short-term retear rates after arthroscopic double-layer repair versus bursal layer-only repair: a randomized controlled trial.
        Am J Sports Med. 2020; 48: 689-696https://doi.org/10.1177/0363546519897033
        • Jeong J.Y.
        • Park K.M.
        • Sundar S.
        • Yoo J.C.
        Clinical and radiologic outcome of arthroscopic rotator cuff repair: single-row versus transosseous equivalent repair.
        J Shoulder Elbow Surg. 2018; 27: 1021-1029https://doi.org/10.1016/j.jse.2017.10.040
        • Lo I.K.
        • Burkhart S.S.
        Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff.
        Arthroscopy. 2003; 19: 1035-1042https://doi.org/10.1016/j.arthro.2003.09.036
        • Ma C.B.
        • Comerford L.
        • Wilson J.
        • Puttlitz C.M.
        Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation.
        J Bone Joint Surg Am. 2006; 88: 403-410https://doi.org/10.2106/JBJS.D.02887
        • Meyer D.C.
        • Wieser K.
        • Farshad M.
        • Gerber C.
        Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair.
        Am J Sports Med. 2012; 40: 2242-2247https://doi.org/10.1177/0363546512457587
        • Nho S.J.
        • Slabaugh M.A.
        • Seroyer S.T.
        • Grumet R.C.
        • Wilson J.B.
        • Verma N.N.
        • et al.
        Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration.
        Arthroscopy. 2009; 25: 1319-1328https://doi.org/10.1016/j.arthro.2009.02.005
        • Pennington W.T.
        • Gibbons D.J.
        • Bartz B.A.
        • Dodd M.
        • Daun J.
        • Klinger J.
        • et al.
        Comparative analysis of single-row versus double-row repair of rotator cuff tears.
        Arthroscopy. 2010; 26: 1419-1426https://doi.org/10.1016/j.arthro.2010.03.013
        • Randelli P.
        • Stoppani C.A.
        • Zaolino C.
        • Menon A.
        • Randelli F.
        • Cabitza P.
        Advantages of arthroscopic rotator cuff repair with a transosseous suture technique: a prospective randomized controlled trial.
        Am J Sports Med. 2017; 45: 2000-2009https://doi.org/10.1177/0363546517695789
        • Randelli P.S.
        • Menon A.
        • Nocerino E.
        • Aliprandi A.
        • Feroldi F.M.
        • Mazzoleni M.G.
        • et al.
        Long-term results of arthroscopic rotator cuff repair: initial tear size matters: a prospective study on clinical and radiological results at a minimum follow-up of 10 years.
        Am J Sports Med. 2019; 47: 2659-2669https://doi.org/10.1177/0363546519865529
        • Ro K.
        • Rhee S.M.
        • Kim J.Y.
        • Kim M.S.
        • Kim J.D.
        • Lee H.
        • et al.
        All-suture anchor settling after arthroscopic repair of small and medium rotator cuff tears.
        Am J Sports Med. 2019; 47: 3483-3490https://doi.org/10.1177/0363546519886547
        • Roth K.M.
        • Warth R.J.
        • Lee J.T.
        • Millett P.J.
        • ElAttrache N.S.
        Arthroscopic single-row versus double-row repair for full-thickness posterosuperior rotator cuff tears: a critical analysis review.
        JBJS Rev. 2014; 2: e6https://doi.org/10.2106/JBJS.RVW.M.00081
        • Sano H.
        • Yamashita T.
        • Wakabayashi I.
        • Itoi E.
        Stress distribution in the supraspinatus tendon after tendon repair: suture anchors versus transosseous suture fixation.
        Am J Sports Med. 2007; 35: 542-546https://doi.org/10.1177/0363546506296310
        • 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: 953-960https://doi.org/10.2106/JBJS.F.00512
        • Sugaya H.
        • Maeda K.
        • Matsuki K.
        • Moriishi J.
        Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation.
        Arthroscopy. 2005; 21: 1307-1316https://doi.org/10.1016/j.arthro.2005.08.011
        • Sun Y.
        • Kwak J.M.
        • Kholinne E.
        • Tan J.
        • Koh K.H.
        • Jeon I.H.
        Nonabsorbable suture knot on the tendon affects rotator cuff healing: a comparative study of the knots on tendon and bone in a rat model of rotator cuff tear.
        Am J Sports Med. 2019; 47: 2809-2815https://doi.org/10.1177/0363546519867928
        • Tashjian R.Z.
        Epidemiology, natural history, and indications for treatment of rotator cuff tears.
        Clin Sports Med. 2012; 31: 589-604https://doi.org/10.1016/j.csm.2012.07.001
        • Teunis T.
        • Lubberts B.
        • Reilly B.T.
        • Ring D.
        A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.
        J Shoulder Elbow Surg. 2014; 23: 1913-1921https://doi.org/10.1016/j.jse.2014.08.001
        • Thomas R.
        • Richardson M.
        • Patel M.
        • Page R.
        • Sangeux M.
        • Ackland D.C.
        Rotator cuff contact pressures at the tendon-implant interface after anatomic total shoulder arthroplasty using a metal-backed glenoid component.
        J Shoulder Elbow Surg. 2018; 27: 2085-2092https://doi.org/10.1016/j.jse.2018.04.017
        • Xu C.
        • Zhao J.
        • Li D.
        Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears.
        J Shoulder Elbow Surg. 2014; 23: 182-188https://doi.org/10.1016/j.jse.2013.08.005