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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

Authors: Cosimo Tudisco, Salvatore Bisicchia, Eugenio Savarese, Roberto Fiori, Dario A Bartolucci, Salvatore Masala, Giovanni Simonetti

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

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Abstract

Background

Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques.

Methods

The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense.

Results

The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients.

Conclusions

To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications.
Level of evidence III. Treatment study: Case–control study.
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Literature
1.
Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL: Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006, 15: 290-299. 10.1016/j.jse.2005.09.017.CrossRefPubMed
2.
Kang L, Henn RF, Tashjian RZ, Green A: Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair. Arthroscopy. 2007, 23: 573-582. 10.1016/j.arthro.2007.01.011. e1-2CrossRefPubMed
3.
Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGil-livray JD: Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am. 2007, 89 (Suppl 3): 127-136.CrossRefPubMed
4.
Kasten P, Keil C, Grieser T, Raiss P, Streich N, Loew M: Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop. 2011, 35: 1663-1670. 10.1007/s00264-011-1262-2.CrossRefPubMedPubMedCentral
5.
Ropiak RR, Zmistowski BM, Ciccotti MC, Rynning R, Williams GR, Fenlin JM: Postoperative Pain after Open versus Arthroscopic Rotator Cuff Repair. 2010, Scottsdale, AZ: ASES 2010 closed meeting
6.
Ma CB, Comerford L, Wilson J, Puttlitz CM: Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am. 2006, 88: 403-410. 10.2106/JBJS.D.02887.CrossRefPubMed
7.
Meier SW, Meier JD: The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy. 2006, 22: 493-497.CrossRef
8.
Milano G, Grasso A, Zarelli D, Deriu L, Cillo M, Fabbriciani C: Comparison between single-row and double-row rotator cuff repair: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2008, 16: 75-80. 10.1007/s00167-007-0382-0.CrossRefPubMed
9.
Saridakis P, Jones G: Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am. 2010, 92: 732-742. 10.2106/JBJS.I.01295.CrossRefPubMed
10.
Smith CD, Alexander S, Hill AM, Huijsmans PE, Bull AM, Amis AA, De Beer JF, Wallace AL: A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am. 2006, 88: 2425-2431. 10.2106/JBJS.E.00697.CrossRefPubMed
11.
Waltrip RL, Zheng N, Dugas JR, Andrews JR: Rotator cuff repair. A biomechanical comparison of three techniques. Am J Sports Med. 2003, 31: 493-497.PubMed
12.
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. 10.1053/jars.2002.32930.CrossRefPubMed
13.
Brady PC, Arrigoni P, Burkhart SS: Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs. Arthroscopy. 2006, 22: 1070-1075. 10.1016/j.arthro.2006.05.007.CrossRefPubMed
14.
Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA: Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med. 2005, 33: 1861-1868. 10.1177/0363546505279575.CrossRefPubMed
15.
Nelson CO, Sileo MJ, Grossman MG, Serra-Hsu F: Single-row modified mason-allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison. Arthroscopy. 2008, 24: 941-948. 10.1016/j.arthro.2008.03.011.CrossRefPubMed
16.
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. 10.1016/j.jse.2006.09.010.CrossRefPubMed
17.
Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y: Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med. 2005, 33: 1869-1874. 10.1177/0363546505278256.CrossRefPubMed
18.
Ahmad CS, Stewart AM, Izquierdo R, Bigliani LU: Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques. Am J Sports Med. 2005, 33: 1667-1671. 10.1177/0363546505278252.CrossRefPubMed
19.
Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS: Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med. 2005, 33: 1154-1159. 10.1177/0363546504273053.CrossRefPubMed
20.
Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D: Can a double row anchorage technique improve tendon healing in arthroscopic rotator cuff repair? A prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med. 2007, 35: 1247-1253. 10.1177/0363546507301661.CrossRefPubMed
21.
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
22.
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. 10.2106/JBJS.F.00305.CrossRefPubMed
23.
Pennington WT, Gibbons DJ, Bartz BA, Dodd M, Daun J, Klinger J, Popovich M, Butler B: Comparative analysis of single-row versus double-row repair of rotator cuff tears. Arthroscopy. 2010, 26: 1419-1426. 10.1016/j.arthro.2010.03.013.CrossRefPubMed
24.
Burks RT, Crim J, Brown N, Fink B, Greis PE: A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med. 2009, 37: 674-682. 10.1177/0363546508328115.CrossRefPubMed
25.
Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V: 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: 1254-1260. 10.1177/0363546507302218.CrossRefPubMed
26.
Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C: Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy. 2009, 25: 4-12. 10.1016/j.arthro.2008.09.018.CrossRefPubMed
27.
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. 10.1177/0363546508315039.CrossRefPubMed
28.
Bauer JS, Banerjee S, Henning TD, Krug R, Majumdar S, Link TM: Fast high-spatial-resolution MRI of the ankle with parallel imaging using GRAPPA at 3 T. AJR Am J Roentgenol. 2007, 189: 240-245. 10.2214/AJR.07.2066.CrossRefPubMed
29.
Duc SR, Mengiardi B, Pfirrmann CW, Jost B, Hodler J, Zanetti M: Diagnostic performance of MR arthrography after rotator cuff repair. AJR Am J Roentgenol. 2006, 186: 237-241. 10.2214/AJR.04.1818.CrossRefPubMed
30.
Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C: Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR Am J Roentgenol. 2004, 183: 343-351.CrossRefPubMed
31.
Jung JY, Yoon YC, Choi SH, Kwon JW, Yoo J, Choe BK: Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology. 2009, 250: 498-505. 10.1148/radiol.2493071548.CrossRefPubMed
32.
Lambert A, Loffroy R, Guiu B, Mejean N, Lerais JM, Cercueil JP, Krausé D: Rotator cuff tears: value of 3.0T MRI. J Radiol. 2009, 90: 583-588. 10.1016/S0221-0363(09)74024-7.CrossRefPubMed
33.
Magee T: 3-T MRI of the shoulder: is MR arthrography necessary?. AJR Am J Roentgenol. 2009, 192: 86-92. 10.2214/AJR.08.1097.CrossRefPubMed
34.
Magee T, Williams D: 3.0-T MRI of the supraspinatus tendon. AJR Am J Roentgenol. 2006, 187: 881-886. 10.2214/AJR.05.1047.CrossRefPubMed
35.
Major NM, Browne J, Domzalski T, Cothran RL, Helms CA: Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary?. AJR Am J Roentgenol. 2011, 196: 1139-1144. 10.2214/AJR.08.1734.CrossRefPubMed
36.
Masi JN, Sell CA, Phan C, Han E, Newitt D, Steinbach L, Majumdar S, Link TM: Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model. Radiology. 2005, 236: 140-150. 10.1148/radiol.2361040747.CrossRefPubMed
37.
Murray PJ, Shaffer BS: Clinical update: MR imaging of the shoulder. Sports Med Arthrosc. 2009, 17: 40-48. 10.1097/JSA.0b013e31819602a6.CrossRefPubMed
38.
Trattnig S, Mamisch TC, Noebauer I: High-field and ultrahigh-field magnetic resonance imaging: new possibilities for imaging joints. Z Rheumatol. 2006, 65: 681-687. 10.1007/s00393-006-0121-9.CrossRefPubMed
39.
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.PubMed
40.
Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987, 214: 160-164.PubMed
41.
Matsen FA, Lippitt SB, Sidles JA, Harryman DT: Practical Evaluation and Management of the Shoulder. 1996, Philadelphia: Saunders C
42.
Arrigoni P, Brady PC, Burkhart SS: The double-pulley technique for double-row rotator cuff repair. Arthroscopy. 2007, 23: 675-e1-4CrossRefPubMed
43.
Cho NS, Yi JW, Lee BG, Rhee YG: Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med. 2010, 38: 664-671. 10.1177/0363546509350081.CrossRefPubMed
44.
Koh KH, Kang KC, Lim TK, Shon MS, Yoo JC: Prospective randomized clinical trial of single- versus double-row suture anchor repair in 2- to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. Arthroscopy. 2011, 27: 453-462. 10.1016/j.arthro.2010.11.059.CrossRefPubMed
45.
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: 1307-1316. 10.1016/j.arthro.2005.08.011.CrossRefPubMed
46.
Burkhart SS, Morgan CD, Kibler WB: The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003, 19: 641-661. 10.1016/S0749-8063(03)00389-X.CrossRefPubMed
47.
Lake SP, Miller KS, Elliott DM, Soslowsky LJ: Effect of fiber distribution and realignment on the nonlinear and inhomogeneous mechanical properties of human supraspinatus tendon under longitudinal tensile loading. J Orthop Res. 2009, 27: 1596-1602. 10.1002/jor.20938.CrossRefPubMedPubMedCentral
48.
Wang VM, Wang FC, McNickle AG, Friel NA, Yanke AB, Chubinskaya S, Romeo AA, Verma NN, Cole BJ: Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair. Am J Sports Med. 2010, 38: 2456-2463. 10.1177/0363546510376817.CrossRefPubMedPubMedCentral
49.
Oh JH, Kim SH, Kang JY, Oh CH, Gong HS: Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med. 2010, 38: 672-678. 10.1177/0363546509352460.CrossRefPubMed
50.
Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K, Galatz LM, Yamaguchi K: Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010, 38: 2435-2442. 10.1177/0363546510382835.CrossRefPubMed
51.
Duquin TR, Buyea C, Bisson LJ: Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med. 2010, 38: 835-841. 10.1177/0363546509359679.CrossRefPubMed
Metadata
Title
Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results
Authors
Cosimo Tudisco
Salvatore Bisicchia
Eugenio Savarese
Roberto Fiori
Dario A Bartolucci
Salvatore Masala
Giovanni Simonetti
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-43

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