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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2017

01-07-2017 | Shoulder

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

Authors: Sung Hyun Lee, Jeong Woo Kim, Tae Kyun Kim, Seok Hyun Kweon, Hong Je Kang, Se Jin Kim, Jin Sung Park

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2017

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Abstract

Purpose

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair.

Methods

A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively.

Results

The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p < 0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique.

Conclusion

The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique.

Level of evidence

Retrospective Cohort Design, Treatment Study, level III.
Literature
1.
go back to reference Andres BM, Lam PH, Murrell GA (2010) Tension, abduction, and surgical technique affect footprint compression after rotator cuff repair in an ovine model. J Shoulder Elb Surg 19(7):1018–1027CrossRef Andres BM, Lam PH, Murrell GA (2010) Tension, abduction, and surgical technique affect footprint compression after rotator cuff repair in an ovine model. J Shoulder Elb Surg 19(7):1018–1027CrossRef
2.
go back to reference Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, Joo MS, Kim DM (2016) Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? J Shoulder Elb Surg. doi:10.1016/j.jse.2016.01.004 Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, Joo MS, Kim DM (2016) Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? J Shoulder Elb Surg. doi:10.​1016/​j.​jse.​2016.​01.​004
3.
go back to reference Behrens SB, Bruce B, Zonno AJ, Paller D, Green A (2012) Initial fixation strength of transosseous-equivalent suture bridge rotator cuff repair is comparable with transosseous repair. Am J Sports Med 40(1):133–140CrossRefPubMed Behrens SB, Bruce B, Zonno AJ, Paller D, Green A (2012) Initial fixation strength of transosseous-equivalent suture bridge rotator cuff repair is comparable with transosseous repair. Am J Sports Med 40(1):133–140CrossRefPubMed
4.
go back to reference Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elb Surg 15(3):290–299CrossRef Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elb Surg 15(3):290–299CrossRef
5.
go back to reference Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87(6):1229–1240PubMed Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87(6):1229–1240PubMed
6.
go back to reference Boyer P, Bouthors C, Delcourt T, Stewart O, Hamida F, Mylle G, Massin P (2015) Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques. Knee Surg Sports Traumatol Arthrosc 23(2):478–486CrossRefPubMed Boyer P, Bouthors C, Delcourt T, Stewart O, Hamida F, Mylle G, Massin P (2015) Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques. Knee Surg Sports Traumatol Arthrosc 23(2):478–486CrossRefPubMed
7.
go back to reference Burkhart SS, Adams CR, Schoolfield JD (2009) A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. Arthroscopy 25(3):274–281CrossRefPubMed Burkhart SS, Adams CR, Schoolfield JD (2009) A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. Arthroscopy 25(3):274–281CrossRefPubMed
8.
go back to reference Cho NS, Yi JW, Lee BG, Rhee YG (2010) Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 38(4):664–671CrossRefPubMed Cho NS, Yi JW, Lee BG, Rhee YG (2010) Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 38(4):664–671CrossRefPubMed
9.
go back to reference Choi S, Kim MK, Kim GM, Roh YH, Hwang IK, Kang H (2014) Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elb Surg 23(11):1675–1681CrossRef Choi S, Kim MK, Kim GM, Roh YH, Hwang IK, Kang H (2014) Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elb Surg 23(11):1675–1681CrossRef
10.
go back to reference Chung SK, Kim SH, Tae SK, Yoon JP, Choi JA, Oh JH (2013) Is the supraspinatus muscle hypotrophy truly irreversible after surgical repair of rotator cuff tears? Clin Orthop Surg 5(1):55–65CrossRefPubMedPubMedCentral Chung SK, Kim SH, Tae SK, Yoon JP, Choi JA, Oh JH (2013) Is the supraspinatus muscle hypotrophy truly irreversible after surgical repair of rotator cuff tears? Clin Orthop Surg 5(1):55–65CrossRefPubMedPubMedCentral
11.
go back to reference Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683CrossRefPubMed Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683CrossRefPubMed
12.
go back to reference Cole BJ, ElAttrache NS, Anbari A (2007) Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 23(6):662–669CrossRefPubMed Cole BJ, ElAttrache NS, Anbari A (2007) Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 23(6):662–669CrossRefPubMed
13.
go back to reference Deniz G, Kose O, Tugay A, Guler F, Turan A (2014) Fatty degeneration and hypotrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg 134(7):985–990CrossRefPubMed Deniz G, Kose O, Tugay A, Guler F, Turan A (2014) Fatty degeneration and hypotrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg 134(7):985–990CrossRefPubMed
14.
go back to reference Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8(6):599–605CrossRef Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8(6):599–605CrossRef
15.
go back to reference Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86(A(2)):219–224CrossRefPubMed Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86(A(2)):219–224CrossRefPubMed
16.
go back to reference Gerber C, Schneeberger AG, Hoppeler H, Meyer DC (2007) Correlation of hypotrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elb Surg 16(6):691–696CrossRef Gerber C, Schneeberger AG, Hoppeler H, Meyer DC (2007) Correlation of hypotrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elb Surg 16(6):691–696CrossRef
17.
go back to reference Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified Mason-Allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched pair analysis. Am J Sports Med 40(12):2777–2785CrossRefPubMed Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified Mason-Allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched pair analysis. Am J Sports Med 40(12):2777–2785CrossRefPubMed
18.
go back to reference Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and hypotrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719–728CrossRefPubMed Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and hypotrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719–728CrossRefPubMed
19.
go back to reference Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83 Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83
20.
go back to reference Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elb Surg 12(16):550–554CrossRef Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elb Surg 12(16):550–554CrossRef
21.
go back to reference Gramstad DG, Yamaguchi K (2011) Anatomy, pathogenesis, natural history, and nonsurgical treatment of rotator cuff disorders. In: Galatz LM (ed) Orthopaedic knowledge update: shoulder and elbow, vol 3. AAOS, Rosemont, pp 149–159 Gramstad DG, Yamaguchi K (2011) Anatomy, pathogenesis, natural history, and nonsurgical treatment of rotator cuff disorders. In: Galatz LM (ed) Orthopaedic knowledge update: shoulder and elbow, vol 3. AAOS, Rosemont, pp 149–159
22.
go back to reference Jost B, Pfirrmann CW, Gerber C (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82(3):304–314CrossRefPubMed Jost B, Pfirrmann CW, Gerber C (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82(3):304–314CrossRefPubMed
23.
go back to reference Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34(3):407–414CrossRefPubMed Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34(3):407–414CrossRefPubMed
24.
go back to reference Kim JR, Cho YS, Ryu KJ, Kim JH (2012) Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 40(4):786–793CrossRefPubMed Kim JR, Cho YS, Ryu KJ, Kim JH (2012) Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 40(4):786–793CrossRefPubMed
25.
go back to reference Kim KC, Shin HD, Lee WY (2012) Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am 94(8):e48CrossRefPubMed Kim KC, Shin HD, Lee WY (2012) Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am 94(8):e48CrossRefPubMed
26.
go back to reference Kluger R, Bock P, Mittlböck M, Krampla W, Engel A (2011) Long term survivorship of rotator cuff repairs using ultrasound and magnetic resonance imaging analysis. Am J Sport Med 39(10):2071–2081CrossRef Kluger R, Bock P, Mittlböck M, Krampla W, Engel A (2011) Long term survivorship of rotator cuff repairs using ultrasound and magnetic resonance imaging analysis. Am J Sport Med 39(10):2071–2081CrossRef
27.
go back to reference Liu X, Manzano G, Kim HT, Feeley BT (2011) A rat model of massive rotator cuff tears. J Orthop Res 29(4):588–595CrossRefPubMed Liu X, Manzano G, Kim HT, Feeley BT (2011) A rat model of massive rotator cuff tears. J Orthop Res 29(4):588–595CrossRefPubMed
28.
go back to reference Maguire M, Goldberg J, Bokor D, Bertollo N, Pelletier MH, Harper W, Walsh WR (2011) Biomechanical evaluation of four different transosseous-equivalent/suture bridge rota-tor cuff repairs. Knee Surg Sports Traumatol Arthrosc 19(9):1582–1587CrossRefPubMed Maguire M, Goldberg J, Bokor D, Bertollo N, Pelletier MH, Harper W, Walsh WR (2011) Biomechanical evaluation of four different transosseous-equivalent/suture bridge rota-tor cuff repairs. Knee Surg Sports Traumatol Arthrosc 19(9):1582–1587CrossRefPubMed
29.
go back to reference Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg 23(4):586–597CrossRef Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg 23(4):586–597CrossRef
30.
go back to reference Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ (2007) Part I: footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):461–468CrossRef Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ (2007) Part I: footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):461–468CrossRef
31.
go back to reference Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ (2007) Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):469–476CrossRef Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ (2007) Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):469–476CrossRef
32.
go back to reference Pauly S, Kieser B, Schill A, Gerhardt C, Scheibel M (2010) Biomechanical comparison of 4 double-row suture-bridging rotator cuff repair techniques using different medial-row configurations. Arthroscopy 26(10):1281–1288CrossRefPubMed Pauly S, Kieser B, Schill A, Gerhardt C, Scheibel M (2010) Biomechanical comparison of 4 double-row suture-bridging rotator cuff repair techniques using different medial-row configurations. Arthroscopy 26(10):1281–1288CrossRefPubMed
33.
go back to reference Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92(3):732–742CrossRefPubMed Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92(3):732–742CrossRefPubMed
34.
go back to reference Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am 89(5):953–960PubMed Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am 89(5):953–960PubMed
35.
go back to reference Tae SK, Oh JH, Kim SH, Chung SW, Yang JY, Back YW (2011) Evaluation of fatty degeneration of the supraspinatus muscle using a new measuring tool and its correlation between multidetector computed tomography and magnetic resonance imaging. Am J Sports Med 39(3):599–606CrossRefPubMed Tae SK, Oh JH, Kim SH, Chung SW, Yang JY, Back YW (2011) Evaluation of fatty degeneration of the supraspinatus muscle using a new measuring tool and its correlation between multidetector computed tomography and magnetic resonance imaging. Am J Sports Med 39(3):599–606CrossRefPubMed
36.
go back to reference Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 344:275–283CrossRef Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 344:275–283CrossRef
37.
go back to reference van de Sande MA, Stoel BC, Obermann WR, a Lieng JGT, Rozing PM (2005) Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography. Invest Radiol 40(5):313–319CrossRefPubMed van de Sande MA, Stoel BC, Obermann WR, a Lieng JGT, Rozing PM (2005) Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography. Invest Radiol 40(5):313–319CrossRefPubMed
38.
go back to reference Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 33(3):163–170CrossRefPubMed Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 33(3):163–170CrossRefPubMed
Metadata
Title
Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?
Authors
Sung Hyun Lee
Jeong Woo Kim
Tae Kyun Kim
Seok Hyun Kweon
Hong Je Kang
Se Jin Kim
Jin Sung Park
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4415-4

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